It was a humid June night in Bannu city in the southern Khyber Pakhtunkhwa area of Pakistan. Summer begins in this region from April and peaks in June. The family in this story lived in the suburban area of Bannu city. There were about 5-6 villages close by and an abundance of guava orchards which was a conducive habitat for snakes and other reptiles.
This family of around 10 adults and children lived in a cemented house with gardens around it. Baby Aaira (also called Mona), around 3 years of age was staying at her maternal grandparent’s house temporarily along with her parents and two elder siblings. Her father, Imran Khan, was a bank employee and had been transferred to Bannu recently. They were in the midst of setting up their residential quarters in the city.
On the fateful night of 11th June, 2019, Aaira was sleeping on the carpeted floor along with her mother, Nazia. Her father was sleeping close by. Around 2 a.m., Nazia felt something cold touching her feet multiple times. She woke up and looked down to find a snake on her feet. Nazia immediately brushed the snake away with her hands and shouted to the other family members alerting them of the snake being inside the house. Around 2.30 a.m., the snake was found and killed by the family members. Everyone in the family sat together feeling relieved that no one was bitten by the snake.
Aaira who had got up due to the commotion was jumping around playfully in between the chatter of the family members. It was around 3 a.m. when Aaira started complaining of stomach pain. She started showing distress in breathing. Her mamu (maternal uncle), Dr Sharukh Khan, checked her breathing and confirmed
respiratory distress due to airway compromise. In a few minutes, Aaira started losing consciousness and flopping her head which is a typical sign of neck weakness seen in patients of krait bite.
The family immediately put Aaira in their Toyota Corolla and drove to Khafila Gulnawaz Teaching Hospital (KGTH) where Aaira’s mamu Dr Sharukh works as a medical officer. The hospital is about 10 kms from their house but since it was night, the distance was covered in 10 minutes. On examination Baby Aaira was flaccid, unresponsive with non-reactive, dilated pupils with stable vital signs.
The pupillary dilation persisted in spite of direct light on the eye. Since doctors at KGTH were not able to ascertain the cause of distress, the family was referred to the Combined Military Hospital (CMH) which was inside the military cantonment area about 5 kms away. Baby Aaira was taken to the 2nd hospital supported by a hand held self-inflating bag to ensure assisted breathing. There was some delay at the gate of the cantonment area where the guard questioned the family to ascertain the reason to enter the restricted area in the middle of the night. Once the guard checked the identities of all the occupants and was satisfied about the genuineness of the case, he allowed the car to enter the cantonment area.
Baby Aaira was finally admitted to CMH, Bannu after almost 3 hours from the time she was bitten. At the time of admission, she was unconscious with high heart rate. The attending doctor asked for a picture of the culprit snake. On examining the image, he identified the same as a krait. Baby Aaira was administered 12 vials of Indian Polyvalent ASV and 6 vials of NIHS ASV (assembled in Pakistan). The arterial oxygen level was as low as 15-20 mm Hg.
On 13th June, 2019, Aaira who had been unconscious for two days finally moved her lips slightly and opened her eyes. She was not able to see anything. The only response was her increased heart rate when a family member called out to her.
In a few hours Aaira again slipped into a deep coma and didn’t respond to verbal commands and painful stimuli for the next few days. On the 6th day she opened her eyes and had symptoms like Nystagmus [a condition of involuntary (or voluntary, in some cases) eye movement]. Doctors in CMH Bannu discussed shifting the patient to a higher hospital as patient would need to undergo tracheostomy. (This is a medical procedure that involves creating an opening in the neck in order to place a tube into the person’s windpipe to assist regular breathing. The tube is inserted through a cut in the neck below the vocal cords. This allows air to enter the lungs). Prolonged tracheostomy has a risk of infection and related complications which would be challenging to manage at CMH Bannu considering the age of the child. Baby Aaira was therefore shifted to Rehman Medical Institute (RMI), a private hospital in Hyatabad, Peshawar via ventilator ambulance on the 7th day of the bite. It took approximately 4 hours to reach the Peshawar based hospital. Aaira was admitted in the children’s ICU.
It was around this time that the author, Priyanka Kadam, was referred this case by Dr Stephen Samuel, an Emergency Medicine doctor practicing in the UK. Dr Samuel shared a message posted by baby Aaira’s family on Facebook requesting expert doctors from other parts of the world to help the doctors on the ground to manage the complicated case of baby Aaira. Dr Samuel’s colleague, Dr Ayaz Mohammed, a Pakistani cardiologist had shared this information with him from social media. It was the 7th day since the bite. Ms Kadam who runs a national level snakebite awareness and management initiative called Snakebite Healing and Education Society (SHE-INDIA) immediately reached out to the family and got in touch with baby Aaira’s aunt Sidra Liaqat. Ms Liaqat shared the latest CT Scans and a few diagnosis papers which Ms Kadam shared with other doctors to seek their opinion based on their experience of treating snakebite patients.
Snakebite experts from India, who are also advisors of SHE-INDIA, Dr Dilip Punde, Dr Himmatrao Bawaskar, Dr Dayal Bandhu Majumdar, Dr Sadanand Raut and Dr Amit Agrawal were contacted copying Dr Samreen, the treating Paediatrician at RMI and Sidra Liaqat (patient’s aunt). Two neurosurgeons, Dr Amit Agrawal and Dr Bhede (Dr Punde’s colleague) confirmed that the patient didn’t need brain surgery. Dr Punde advised tracheostomy and shared his experience of successfully treating krait bite patients in his hospital.
Tracheostomy was done after 2 weeks from the bite. A few days later baby Aaira started showing very little response like opening of eyes, lip synching what her relatives were saying etc.
While baby Aaira was able to follow verbal commands, she could not see anything. The nystagmus like condition returned. While examining the patient, it was observed that her pupils showed no response to light. However, within a few days baby Aaira was able to assess the level of darkness. When the lights were on, she would tell her family members that it is “less dark” than when the lights were switched off. On the 19th day from the bite, the patient experienced slight vision. She was able to recognize her family members at a distance of 2 to 3 feet. Patient started improving and the tracheostomy tube was taken off. She was discharged from the hospital on the 21st day of the bite and asked to come for regular check-ups as an outpatient. The family stayed on in Peshawar for another week to monitor Aaira’s health and be in the same city in case there was a complication. They finally returned to Bannu after almost one month of the near fatal bite incident.
While at home, Baby Aaira’s vision was still blurred and she suffered severe weakness in her muscles, especially the left side of her body. She needed assistance to get up from bed and walk around. The physical challenges made her irritable and she would bite anyone who came close to her. A good palliative care by the family members ensured Baby Aaira’s condition improved over the next few days. Strength slowly returned to her limbs and she started walking around. On her visit to the RMI hospital in Peshawar for a check-up, her treating doctors were pleasantly surprised to see her full recovery.
Today, Baby Aaira is just like any other normal child, full of playfulness and mischief. The ordeals she and her family suffered due to the snakebite is behind them as the family prepares to send her to a beginners school.
The total cost of treatment in this case was close to PKR 10 Lakhs. This child could be saved as she is from an economically well to do family. , Hundreds of victims of snakebites in Pakistan die or suffer life changing disabilities due to non-availability of treatment. Many are referred to higher hospitals which results in serious condition of the patient and also pushes families into further poverty.
Written by Priyanka Kadam and Sidra Liaqat.
This incident occurred on 26th August, 2019 at Narmada Jeevan Shala run by Narmada Navnirman Andolan. This tribal school is situated in Thuvani in Dhadgaon block, Dist Nandurbar, Maharashtra. The school is constructed out of local materials like bamboo plastered with mud and cow dung. The bamboo woven walls have gaps that exposes the dwellings to all kinds of creepy crawlies. To make matters worse, there has been an increase in snake sightings in the area due to backwater of the Sardar Sarovar Dam project.
Around 2:00 AM Rohit Padvi and Pravin Vasawe, both boarders of the Narmada Jeevan Shala, studying in class IV, started complaining of pain in their abdomen. Due to lack of cellular network and bad roads, the teachers Mangu Pawara and Sukalal Pawara were not able to call an ambulance. Since the children were crying incessantly, Mangu rushed Pravin Vasawe to a Primary Health Centre in Roshmal on his motorcycle.
This PHC is situated in a hilly terrain with bad roads. On the fateful night, it was raining which made the drive difficult to negotiate on the slippery mud road in complete darkness. After much difficulty Mangu Pawara reached Roshmal PHC with Pravin Vasave. He found that the PHC had no doctors. Mangu Pawara then rushed Pravin to Dhadgaon Rural hospital, about 30 km away, where the child was declared brought dead.
In the meantime, the second boy, Rohit Padvi’s condition was also getting serious. To add to the predicament, there was no mode of transportation left. After waiting for help, the teachers mounted him in a makeshift stretcher; a cloth tied to two bamboo sticks and carried him up to the main road, which was 15 minutes away. He was then taken to the hospital in an ambulance, but he too died on the way.
The two children’s post-mortem revealed that both boys had died due to snakebite envenoming. Pravin was found to have been bitten behind his ear and Rohit on his hand. The teachers said that both boys were crying through the night, but no one suspected snakebite.
The author visited the Roshmal PHC on 8th Jan 2020. The state of the building was thoroughly dilapidated. All the windows of the PHC had shattered panes. Rooms were filthy with rat droppings and stains from months of neglect. There were no toilets even for staff. In case of an emergency, the staff has to answer to nature’s call in the nearby hillock.
This PHC also has no electricity and therefore cannot store vaccines required for the Out Patient Dispensary (OPD). The facility did have a stock of 70 Anti Snake Venom vials in the cupboard in the doctor’s room. There were two brand new and unused Ambu bags. On inquiry, none of the staff present knew how to intubate a patient in an emergency situation.
As per the staff there, they close the hospital between 4-5pm as driving back in the dark is dangerous.
On the fateful night when the Thuvani children were bitten, the second doctor, who should have been manning the PHC in the night shift was not available.
The author has witnessed similar situations in other states as well. Even in places where a doctor is available, snakebite patients are referred to district hospitals. In many cases, patients die on the road while being transported to a higher hospital. Unless our PHCs are fully functional and able to stabilize patients of medical emergencies, cases of deaths especially due to snakebite envenoming will not go down.
This is a serious situation. The status of Roshmal PHC is merely the tip of the iceberg. There are tragedies happening or waiting to happen at innumerable places and the victims are usually the tribal or rural poor whose passing does not affect anyone. Life goes on as if they never existed. The saddest part is that these deaths could have been prevented.
Written by Priyanka Kadam, Jan 2020.
This incident happened in June 2016 in Arasampatty village situated in Pochampalli Taluk, Krishnagiri District, Tamil Nadu state. A V Kannan is a 64 year-old coconut farm owner. His farm of about 10 acres of palm trees is his main source of livelihood.
This farm has a good population of Russell’s vipers and Spectacled cobras thanks to the abundance of trees, bushy shrubs and leaf litter, a good rodent and frog population and water that is used for irrigation. It was around 5 pm. As usual, Kannan was inspecting his farm on that fateful evening and didn’t notice the Russell’s viper which was resting near where he stood. He stepped on it unknowingly and sustained a bite on his lower right leg.
His family and friends rushed him to a private hospital in Krishnagiri within 90 minutes of the bite. His life was saved but the bite wound festered. He was discharged from the hospital after 20 days and was instructed to come every second day for wound management. Due to further secondary level infection, he was asked to get admitted again for a fasciotomy and this time he stayed in the hospital for 15 days. It took almost 3 months for the wound to fully heal.
The total cost of treatment came to Rs 7 lakhs. This, after he received a healthy discount from the private hospital due to his social connections and cordial relations with the management.
More than 50,000 people die annually from snakebites in India and five times that number suffer snakebite related morbidity which results in disabilities, loss of livelihood and financial stress. These victims of snakebite come from the most impoverished backgrounds. They struggle to receive treatment in government hospitals as many primary health centres are not equipped to treat snakebites. While district hospitals have the infrastructure to treat snakebites, the large number of referrals from block hospitals creates a bottle neck. Snakebite envenoming is a medical emergency and needs ICU support. Many times during the peak bite season (monsoons), patients are turned away and referred to other hospitals when an ICU bed is not available.
The author visited the Krishnagiri District hospital to understand how snakebite treatment was managed there. There were no patients admitted there perhaps as it was the month of December – a period when lesser number of snake bites are reported. However, the author did meet snakebite victims in a private hospital that was about a 10 minute drive from the District hospital.
A V Kannan, whose case we have described, is from an affluent village family and hence he was able to receive the necessary treatment in a private hospital.
Written by Priyanka Kadam, ©December, 2019
Snakebite incident as shared by field reporters Bikash Bharali and Assistant Journalist, Samim Ali from Golaghat, Assam
Twenty-five-year-old Bikash Bharali from Golaghat, Assam sent me a WhatsApp message sometime in July 2018. He was reporting a snakebite death of a father-daughter duo. Bikash had been following Snakebite Healing & Education Society’s work on social media. He was aware of our efforts to document victim stories. This is his contribution towards the cause of minimizing snake bite deaths in our country.
A family of seven lived in the slums near the railway tracks off Telihaal near Golaghat railway station. Thirty-eight-year-old Gohoni Ganju, the head of the family, was disabled and eked out a living as a tutor and by doing odd jobs. His wife, Rakhi worked as a maid. They had two daughters and three of Rakhi’s relatives also lived with them.
It was the night of 11th July, 2018. The monsoon had set in. The two roomed thatched hut did not have electricity. No one saw the Bungarus niger (Greater Black krait) enter their dwelling. Around 11.30 p.m. when all the family members were asleep on the floor, the krait bit Gohoni on his back. In a reflex action he shook the snake away which fell on his six-year-old daughter Dipanjali (Munmi).and entwined itself on her leg. As she moved, it bit her on the right hand a little above the wrist.
If only the family had used a mosquito net, perhaps they would have been saved from this tragedy.
No first aid was given to the victims at home. The 108 ambulance services were contacted and by 12.30 a.m. the father and daughter were brought to the District Hospital, barely 5 kms away. While being transported to the hospital, both the victims were in a conscious state. Gohoni was experiencing respiratory distress and frothing from the mouth.
Gohoni lost consciousness a little before reaching the hospital (as informed by the people accompanying him). The attending doctor at the hospital declared him brought-dead.
Dipanjali was admitted to the ICU where she too breathed her last within 15 minutes of admission as shared by her mother, Rakhi. No post-mortem was conducted on the dead bodies. Both the bodies were carried back home. Since it was night time, the family and neighbours waited for dawn to cremate the dead father and daughter. A few hours after the bodies arrived home, the family members saw some air bubbles coming out from Dipanjali’s right nostril. Seeing this, they sought the help of a local quack, who couldn’t be of any assistance.
Gohoni is survived by his wife and two-year-old daughter, Rupanjali, an aging mother-in-law and teenage brother-in-law and a sister-in-law. Rakhi earns approximately Rs 4,000 per month which is not enough to support the family of five.
The district hospital apparently does not maintain proper records of snakebite cases. While total number of vials stocked in various departments within the hospital was close to 50, the antivenom was hardly used as shared by a nursing staff. As per the staff most snakebite cases which arrived at the hospital were either of non-venomous snakes or those who were brought dead on arrival.
Profile of the field reporters:
Bikash Bharali – Bikash has a regular job in a financial firm and in his free time he visits villages in his area to spread awareness regarding snakes, and how to live with them without getting bitten. Since the area where he lives has wide-spread faith healing practice, Bikash conducts awareness programs in local communities in his free time. He also teaches the communities how to manage and stabilize a snakebite victim while waiting for an ambulance to take them to the nearest hospital.
Samim Ali : Samim is an Assistant Journalist from Golaghat, Assam and mostly assists in covering news bytes in the Golaghat district. He informs Bikash wherever he comes across any snakebite incidents in the district. The pictures of the deceased victims and family have been shared by Samim.
In most of India snakebite is a phenomenon that can happen anywhere and at anytime. This story validates this statement .
Jagdish Bhai Chandra Trivedi is an octogenarian living with his 76-year-old wife Vatsala in Tirupati Akruti Green Complex in Ahmedabad. The couple have seven daughters and one son – Sagar Trivedi, who lives in Dubai since the last 15 years. He works in the Gold & Diamond industry. Incidentally Sagar and his family were visiting his parents when this incident occurred.
Tirupati Akruti Green is a residential complex that has six high rise buildings with a total of 432 flats. Jagdish Bhai lives on the 8th Floor. On 14th April 2018, Jagdish Bhai got up around 6 am and made himself a cup of tea. He then went to the drawing room to open the window and felt a pin-prick like pain while drawing the curtain. Since he was still feeling sleepy he didn’t check what had caused this. When he felt the pain again, he looked down and found a small snake around 18 inches long at his feet. Jagdish Bhai was taken aback. He quickly woke his wife and son.
Sagar couldn’t believe what his father told him. The snake was still coiled near the dining area. Sagar immediately tied a tourniquet around his father’s leg (a little above the bitten area) and called the 108 ambulance services.
[Please note that tourniquets are harmful when used as first-aid in a venomous snakebite situation as it leads to snakebite related trauma in the bite area and subsequent morbidity especially in a viper bite].
The ambulance arrived within 15 minutes. Jagdish Bhai was taken to the Sola civil hospital which is approximately 5 kms from their residence. The ambulance arrived at the hospital in 10 minutes. Jagdish Bhai was immediately taken to the casualty ward and his treatment started within 30 minutes of the bite. He was given 10 vials of snake antivenom along with supportive medicines. He was discharged on the fourth day of the bite. Since Jagdish Bhai enjoys good health even at the ripe age of 81 his recovery was quite uneventful.
The snake which bit Jagdish Bhai was a Saw Scaled Viper. The family was still perplexed about the presence of a venomous snake inside a multi-storied building. Moreover Saw Scaled vipers are generally not found close to human habitats. This species of snake lives in rocky terrain in the plains and hills alike. Generally nocturnal in nature, it likes to rest at the base of thorny shrubs during the day.
Two events that had happened around the bite incident that could potentially explain the snake’s presence:
While this story has a happy ending, one is forced to think that snakebites can occur just about anywhere in the country. It is therefore of utmost importance that hospitals be equipped with antivenom, supportive drugs and a ventilator. The medical staff should also undergo appropriate training to manage snakebites.
Note: The incident was reported by Jigar Upadhyay, an animal rescuer and wild life conservationist living in Ahmedabad.
Written by Priyanka Kadam (as narrated by Sagar Trivedi).
This is a story of a father who had to take the toughest decision of his life – to donate the organs of his only child who was brain dead due to delayed treatment for a venomous snakebite.
In the first weekend of November 2017 Himanshu Vora, a 42-year-old lawyer from Bhavnagar, Gujarat, along with his wife Nita and 10-year-old son Manan went to Diu, a union territory near Gujarat, for a holiday. The family checked into the Kohinoor Resort in Diu on Friday, 3rd Nov and were slated to check out on Sunday, 5th Nov 2017. The resort had a swimming pool and play area for kids and Manan had a very good time frolicking in the water. The family spent the entire Saturday outdoors and visited the nearby local market in the evening. During their absence the hotel room service cleaned their room and changed the bedsheets.
The family came back late on Saturday night and went to sleep. Himanshu slept with his son on the double bed and Nita slept on the extra single bed close by. Around 7.30 am on Sunday, Manan complained of pain in his right shoulder. As Manan got up, Himanshu noticed a small blood stain on the bedsheet.
Within 10 minutes, Manan complained that his vison was blurred. He then wanted to go to the toilet and while sitting on the commode he started feeling nausea. Himanshu was perplexed and started looking for an insect that may have bitten his son. He looked all around. He even pulled the bedsheets…nothing! He then moved the pillow that Manan had used. To his horror, he found a sub-adult cobra resting under the pillow that his son had used. The snake hissed in self-defense and Himanshu ran towards the bathroom shouting for help.
The room they were allotted was on the ground floor. Himanshu called out for help from the balcony of his room in response to which the hotel staff came with a snake catching stick to relocate the snake.
Himanshu and Nita immediately took Manan to the newly constructed local Govt hospital in Diu which was 5 minutes away from the resort. Doctors in the hospital examined Manan. The hospital had only one vial of antivenom which was administered to Manan. He was then referred to Una, a small town close to Diu, for further treatment. By now Manan was experiencing respiratory distress. The hospital staff frantically looked for the driver of the ambulance parked in its compound. They were able to trace him only after 45 minutes. By then precious time was lost.
The ambulance that arrived to take Manan had an oxygen cylinder but no oxygen mask. Due to this, Manan was not given ventilatory support while being transported. By now, Manan was suffering immense respiratory distress.
Himanshu was uncontrollably distressed and tried reaching as many people as possible who could help to save his son. The ambulance reached Una around 9 am. Manan was admitted with cardiac arrest. Dr Divyakant Solanki immediately resuscitated him and put him on life support. They then administered 10 vials of antivenom and another 6 vials after 6 hours. The doctors and Manan’s family waited for him to revive after he received treatment. Hours passed but Manan did not revive consciousness.
After 24 hours of admission at the hospital in Una, doctors treating Manan informed the family that the patient was stable and his heart was functioning normally but there was no brain activity. By now Himanshu’s extended family had arrived at Una.
Manan needed to be in a hospital where they could carry out further tests. The doctors discharged him late night on 6th Nov and he was rushed to a hospital in Bhavnagar in the wee hours of 7th Nov, 2017. A CT scan at the Bhavnagar hospital showed no brain activity. On 8th Nov, the treating doctor approached the parents to counsel them about the condition of their brain-dead child and whether they wished to donate his organs. Himanshu and Nita were horrified at this suggestion and questioned the doctor’s ethics for suggesting such a plan when it could be seen clearly that their son’s heart was functioning normally.
It took some convincing and eventually the parents decided to donate their son’s organs. Manas’s liver was given to a 65-year-old male patient from Ahmedabad. His kidneys were donated to a 44-year male from Baroda and a 49-year male patient from Morbi (near Rajkot).
Manan was born on 2nd March 2007 and died on 9th Nov 2017. He was a foodie, loved to draw and enjoyed swimming. Besides cricket, he was also good at math. He was unsure whether he should be a pilot or a chartered accountant when he grew up.
It was hard for Manan’s parents to cope with his loss. Eventually they visited each of the three organ recipients and continue to keep in touch with them on a regular basis.
It is six months since Manan’s death. Everyday his parents begin their day by remembering how they spent their last few days with Manan. The self-searching journey of the grieving parents continues.
The resort staff were well aware of the presence of snakes on their property and had snake handling equipment to relocate / catch snakes. How ever there was no signs of safety nor preparedness in a case of emergency in a snakebite situation. To compound the issue, the hospital in Diu did not have a stock of snake antivenom. While the hospital was a newly constructed facility having OT (Operation Theatre), it was not equipped to handle snakebite cases. Considering the fact that there is a healthy distribution of venomous snakes in Diu, it is but logical that both, the resort and the local hospital should have been equipped to handle such situations.
Manan didn’t die from snakebite; Absence of snake antivenom killed him!
Written by Priyanka Kadam (as narrated by Himanshu & Nita Vora).
This is the story of Yashodhara Kadu, a 21-year-old young mother from Mumbai, Maharashtra. Yashodhara was married to Chottu Kadu on 10th May 2014. She was a local girl and shifted to her in-law’s place in Aarey Milk Colony’s hamlet called Jiwacha Pada. It is situated on a slope with tiny huts built at different levels connected by narrow cobbled pathways built in a step-like fashion. The entire hamlet is spread within a 500 meter radius. The inhabitants dump garbage in open spaces inside the hamlet. This attracts feral animals and rodents. And the feral animals and rodents attract predators like leopards and snakes.
Bite incident: 11th July 2017 was just another day and Chottu Kadu was getting ready for work. He has been working as a delivery boy at The Cha House in Goregaon East since the last 7 years. He left home around 11.30 am. Yashodhara asked him to have lunch but he was in a hurry. She was busy putting out clothes to dry. Little did Chottu know that this was the last time he would see his wife alive.
Yashodhara and Chotu Kadu along with their 7-month toddler, Avani, lived in a mud hut surrounded by shrubs and vegetable climbers. Since the dwelling was made of mud and bamboo, rodents easily burrowed in and around the house.
Around 1 pm Yashodhara went to catch a nap after having her lunch. She was lying on the floor breastfeeding her daughter Avani when she felt a sharp pain on her upper back. Since she couldn’t see the bite area, she ran to a neighbor to ask them to check her back as she was experiencing pain in the bite area. The neighbors could see two distinctive fang marks from where blood seemed to ooze out. They said it looked like a snakebite. Hearing this, Yashodhara panicked and began to weep out of extreme anxiety. By now more neighbors had gathered. The onlookers hurried to take her to the hospital which was a few kms away.
As the hamlet is on a slope Yashodhara was carried uphill till the main road from where she was taken to the Balasaheb Thackeray Trauma Centre situated on the Western Express Highway, Jogeshwari (East) by auto rickshaw. The group reached the hospital within 30 minutes of the bite. Chottu was informed and asked to come directly to the hospital. He reached the hospital in 15 minutes. Doctors in the casualty ward declared Yashodhara dead on arrival.
Yashodhara’s body was sent from Thackeray Trauma Centre to the Siddharth Hospital in Goregaon East for a post mortem. The police also arrived to investigate the cause of death. Yashodhara’s body was handed over to Chottu and family the same evening and she was cremated around 12.30 am.
The family was nervous about Avani’s health as she was suckling on her mother’s breast when the bite had occurred. She was admitted to the hospital and kept under observation for a day.
During the time that the incident had occurred, Avani was solely on breast milk. In the coming days she suffered stomach upset and general ill health as she was taken care of by family and friends. Today she is 15 months old and lives with Chottu’s cousin’s family. Chottu has abandoned the mud house where he lived and has shifted to another residence. The family struggles to bring up a child who is too young to grieve her mother’s death.
Within a few weeks of the tragic incident, different NGOs in Mumbai came together to work on a mitigation plan for better medical facilities and community awareness regarding snakebites in the 27 hamlets situated in Aarey Milk Colony. Snakebite Healing and Education Society conducted the first Snakebite Awareness workshop at the community centre in Jiwacha Pada within a month of the tragic incident.
Written by Priyanka Kadam as narrated by Chottu Kadu
Aarti Jelia was a 14 yr old student of Class 9. She lived in Khilchipur village in Dist Sawai Madhopur, Rajasthan. This is a largish village with an approx. population of 10 thousand villagers. Khilchipur has four Government schools and six private schools. Aarti was the third child. She had two older sisters and a younger brother.
Image: Priyanka Kadam, Snakebite Healing & Education Society
Bite Incident: On 6th Sept 2012, as a part of her daily routine, Aarti went to help in the fields for some time. On return, she studied a bit, had her dinner and went to sleep around 10.30pm. The three girls used to sleep on single cots next to each other. Aarti’s cot was in the middle. A little after midnight, she felt a slight pain on her left thumb. Aarti switched on the light and looked for what had bitten her. She woke her other sisters. They found an adult Common Krait (highly venomous snake) coiled under the pillow of the elder sister.
Parma Devi, Aarti’s mother panicked when she saw the snake. Her husband was away for some work. The four kids and mother huddled in one corner of the room. Meanwhile the snake remained coiled on the bed in the same place for more than 3 hours. It was finally killed by a neighbor. Aarti started showing envenomation signs after almost 4 hours from the bite. Relatives and neighbors advised Parma Devi to call the local faith healer.
The healer performed rituals on Aarti. Her condition kept deteriorating. She suffered pain in her throat and abdomen. Her breathing became labored. Aarti’s condition kept deteriorating and she breathed her last around 5pm. She was taken to the Government Hospital in Alampur, Sawai Madhopur where she was declared dead on arrival.
The family was devastated. Aarti was the brightest amongst her siblings. Parma Devi worked hard in a local cottage industry called Dastakal Kendra to ensure her children get good education, especially Aarti who showed a lot of promise.
In the following days, Parma Devi was advised to engage the faith healer once again to ensure no bad luck befell on her family in future. The healer charged her Rs 3K to insulate all corners of her house with the power of his mantras.
Image: Priyanka Kadam, Snakebite Healing & Education Society
2 years after this tragic loss, in 2014, one of Parma Devi’s daughter trained to be a nurse and started working in a local hospital. She saw many cases of snakebite envenomation wherein patients were brought to the hospital, and survived. The girls lament that if they would have taken their kid sister to the hospital, she would be live today.
The author of this story met Parma Devi, Aarti Jelia’s mother when she was conducting a snakebite awareness workshop at Dastakal Kendra in Ranthambore, Sawai Madhopur. Parma Devi shared her own experience which made the author visit the Jelia house out of curiosity as Parma Devi mentioned they still see snakes around their house. The two-roomed cottage was creatively built with beautiful flower shrubs adorning the porch. Similar bushy plants variegated the garden which also had a few medium sized trees. One tree grew close to the house, its branches reaching out to the windows and the roof. Tendrils of a creeper growing on the tree were spread out on the roof. On one side of the compound wall was a stack of unused bricks piled up for future use. This was a perfect habitat for a snake to free range and call it home.
Image: Priyanka Kadam, Snakebite Healing & Education Society
The author suggested to Parma Devi and her son to cut the shrubs close to the house and the garden pathway and prune the trees touching their dwelling. She also advised not to grow creepers in close proximity of the house as such plants act as a support to facilitate free movement of snakes. The author also suggested to clear all debris in and around the house to ensure rodents and snakes do not seek shelter in the lose pile.
Written byPriyanka Kadam
Field Coordinator : Govardhan Meena, Sanctuary Asia.
Ranidevi is a 23 year old widow living in Ledhgai village in Latihar District, Jharkhand. Ranidevi was married into an agrarian family about four years ago. Little did she know that she would become a widow with a 5-month-old toddler to take care of very soon.
It was the month of July 2014. Ranidevi’s husband, 24 year old Mukhi Singh Khaiwar, was tilling his field to sow maize. It was around 12 noon. As he went about doing his work, Mukhi didn’t see the Russell’s viper in the bushes next to the fields. The snake was disturbed and Mukhi was bitten by it. Initially the family resorted to faith healing. 30 minutes into the ritual, the family realized his condition was deteriorating and they rushed him to the Mission Hospital in Barwadih, approximately 5 km away from Ledhgai village.
At the Mission Hospital, Mukhi was given a tetanus injection and referred to the Mission Hospital in Tumbagada, Satbaruah. No details are available about the treatment received at the Tumbagada hospital. He was later referred to the Government Hospital in Ranchi.
Mukhi’s condition deteriorated in the next few days and he died on the 8th day of the bite.
He was survived by his 5-month-old toddler (now 3.5 years old), his widow Ranidevi, his younger brother and his mother. The family is struggling to come to terms with his untimely death.
This case ended in tragedy only because there was no tertiary level hospital close to the victim’s village equipped for snakebite management. .
Snakebite Healing & Education Society is documenting this and many other tragic cases where victims lost their lives not because they were bitten by a venomous snake but due to lack of treatment. Snakebite is a treatable disease. If there were hospitals in every district that was equipped to treat snakebites and other life threatening diseases, stories such as Mukhi Singh’s would never have a tragic ending.
Written by Priyanka Kadam.
This is a story about a 50 yrs old paralyzed woman, Viviyana Chauranth from Chipadoha in Latehar district of Jharkhand state. The backdrop to her condition is a venomous snakebite that was inflicted by a Russell’s viper.
Incident: On 8th June, 2013, Pradeep Kerkatta, a 40-year-old farmer was returning home with his wife. It was around 8:30pm. The couple was walking back home with the bicycle in tow. There were no street lights but as they were locals they knew the way home even in the dark.
The couple didn’t see an adult Russell’s viper crossing the road. The snake got entangled in the bicycle’s front wheel and started thrashing. Pradeep reacted wondering what had happened. Within a few seconds, he was bitten 3 times near the ankle area. The couple panicked and hastened home.
That night, the family consulted a local herbal medicines healer. The healer, Pauru Nageshiya gave him a concoction to drink. The patient was vomiting and the herbal concoction was also thrown up. Next day, the family and a few neighbors took Pradeep to Chandandi Carmel Hospital. This place is a 3-hour drive from where Pradeep Kerkatta lived.
Pradeep was given treatment for 7 days in Chandandi Carmel Hospital. We do not know if the patient was administered Antivenom and what was the further course of his treatment at Carmel Hospital in Chandandi. During this time Pradeep’s doting wife never left his side. Pradeep’s condition deteriorated during the week and he died on 15th June 2013. He is survived by his wife and seven children.
After Pradeep’s death, his wife started drinking to forget her pain. Her addiction to country liquor took a toll on her health. She was left paralyzed and bedridden about two years ago. The family has gone through countless hardships and struggle to keep afloat. Snakebite is not just a medical condition- it has a socio-economic effect on the victim’s family. Pradeep’s unfortunate and untimely death has left his family struggling for even basic sustenance. Some of his children are school dropouts and daily wage workers to support their large family.
Written by Priyanka Kadam.
This is the story of Kaluram’s family which lost 3 generations of women to snakebite.
Kaluram is a 23 year old farmer with a small tract of land and three buffaloes. He stays on his farm which is about 1.5 kms away from Village Khawa in Sawai Madhopur district of Rajasthan. He grows wheat, gram and vegetables for his family’s consumption. Kaluram is married with two young children below the age of five years.
The first death by snakebite in his family happened in 2001. Those days Kaluram’s family stayed in another house built out of brick and mortar. The small dwelling of two rooms was surrounded by fields where the family grew crops. Kaluram was 8 years old when his mother Prembai was bitten by a venomous snake. It was the month of May. Kaluram’s sister asked her mother for some onions along with the food. As the mother reached out to the onion bunch hanging in the corner, a cobra resting behind the bunch bit her finger. A tight tourniquet was tied to Prembai’s hand and she was made to walk to the village which was about 1.5 kms from their house. She was then put on a tractor and taken to the local Balaji (Hanuman) temple. Prembai died on the way to the temple. She was 35 years old and survived by three daughters and a son (Kaluram).
Myth: The family believes that if she had reached the temple on time she would have survived the venomous bite.
A few years after Prembai’s death, Kaluram’s 6 year old sister, Manchaiti, was bitten around 3 a.m. on an October night when she was asleep. There were no visible bite marks on Manchaiti’s body. Initially she was fine. She got restless only after about 2.5hours of the bite and started experiencing respiratory distress. Her mouth was frothing as she thrashed around. The family again started for the Balaji temple to cure her. Manchaiti however died on the way around 7 a.m.
Myth : The family believes that Manchaiti died as she was brought outside the house. The villagers believe that venom potency gets higher when one crosses the threshold of the main door.
In August 2012, Kanidevi, Kaluram’s 65 year old grandmother was bitten when the family was busy in the fields. Kanidevi was last seen alive at 4 p.m. As she was resting indoors and the family members were toiling in the fields, no one heard or saw anything. Around 8 p.m. when one of the family members went to serve her dinner they saw her lying lifeless. Kanidevi had a dark bite mark on the side of her torso and dried saliva around her mouth. Her face was bluish. She was taken to the village priest who declared her dead.
India is steeped in myths and dogmas around snakes and snakebites. The majority of the population believe in myths in some form of the other. Religion and faith healing form a major part of the snakebite treatment in India. Rajasthan has many temples that cater to snakebite cases. India has more than 300 species of snakes out of which only 4 species of venomous snakes are commonly found across the mainland. Since most bites are from non-venomous species, the victims survive and the faith in religious practices deepens.
In the above story, the prognosis by the village elders after 3 deaths due to snakebites in a span of eleven years, was that the house was cursed by an evil spirit. Kaluram abandoned their home and built another dwelling about a kilometer away. This house has the same backdrop as his previous house. The structure is surrounded by fields, buffaloes tethered very close to the house (as the family is based in Ranthambhore which is tiger country), dried wood and stacks of cow dung cakes (used as fuel for cooking), unplastered walls with wedges and holes between bricks that can host small creatures and snakes. The whole scenario is basically a haven for rodents and snakes.
Snakebite Healing & Education Society gathered Kaluram’s family and a few others working in the fields nearby and gave them information on how one can live with snakes without getting bitten. They were taught how simple basic changes could remove the food and shelter that rodents and snakes thrive upon.
Our Mantra : Keep the faith but rush to the hospital in a venomous snakebite scenario.
All three deaths in the above true story are unrecorded deaths as the victims were not taken to the hospital nor the incident reported to the local Police station.
Written by Priyanka Kadam
Field Co-ordinator: Goverdhan Meena, Sanctuary Asia.
Thursday, March 17, 2016. At around 10.30 am my phone rang. It was displaying an unknown number. Someone wanted to report a snakebite case from Rajasthan. The caller introduced himself as Rohan Shringarpure, a scientist working with Bombay Natural History Society (BNHS) posted at Bhopal as Centre Manager for Vulture Conservation. His colleague Purushottam Ingle had guided him to reach out to Snakebite Healing and Education Society to report a peculiar case of snakebite. Purushottam had looked for us on the internet and found our contact details on the SHE website.
The victim was in a remote village in Rajasthan. He was bitten about 3 days ago, supposedly by a snake and the family had restored to faith healing at the local temple. The boy was developing black patches on his body. His urine seemed blood red – signs of Hematuria (presence of blood in the urine).
The author was busy attending an important meeting and called her colleague Vishal Santra based in Kolkatta, West Bengal to help guide the victim’s family take him to the nearest hospital. Vishal spoke to the family and guided them regarding importance of timely treatment as it seemed like a case of venomous snakebite.
Victim’s background: Jeetu Gujjar is an 18-year-old lad from Vallabhgadh village, Tehsil Bhusawar, Dist. Bharatpur, Rajasthan. He was then a second year under graduate student in a college about 10 kms from his village. The eldest amongst four siblings, Jeetu belonged to the shepherd community. They owned huge flocks of goat and sheep.
On 15th March at around 9 p.m. Jeetu was returning from the Hanuman temple. He stepped on something in the dark and felt a sharp piercing pain on his toes. When he reached home, he saw blood oozing out of two clear fang marks. The family concluded that it was a snakebite. Jeetu was taken to the village priest who warmed some neem leaves and applied it to the bite area. After chanting a few mantras, Jeetu was packed off and asked to return the next day for more healing.
The ‘treatment’ didn’t provide any relief to Jeetu. In fact the bite area had swollen accompanied by extreme tenderness. In the meantime, Jeetu’s aunt’s husband Timan Singh who was posted as a Sr Vulture keeper at the Bhopal facility of BNHS (Madhya Pradesh) called them and was told about Jeetu’s ordeal. Timan Singh related this incident to Rohan and Purushottam and that’s how the two scientists had sprung to help an unknown boy in a village hundreds of kms away.
A day after Vishal Santra had called the family, the author called to inquire about Jeetu. She was told that the patient was still at home. The author reasoned with the family and asked them to take Jeetu immediately to the hospital in Jaipur as Jeetu was bleeding from his gums by this time. The author knew there were insufficient facilities at Bharatpur to treat renal failure cases. She put an alert on her phone to inquire about the patient in the afternoon. The family was still at home in the afternoon when she called. The family’s easy approach annoyed the author and she castigated them to leave for Jaipur immediately.
Despite the author’s pressure to leave immediately, the family finally started for Jaipur only that evening. By this time, Jeetu was bleeding from his nose. Hatesingh Gujjar, Jeetu’s father along with other family members took the train from Bayana Junction (about 25 kms away from Vallabhgadh) to Jaipur at 10pm and reached Jaipur in the middle of the night around 1 a.m. The patient party had a short snack at the railway food stall and proceeded around 4 a.m. for the Govt Hospital in Jaipur.
The author had asked the family to call her the moment they reached the hospital so she could speak to the doctor on duty. The family called as promised and the author provided a quick background of the case and also contact numbers of two prominent snakebite expert doctors in case the doctor on the ground would like to consult in case of renal complications.
Jeetu was admitted early morning on 23rd March 2016. Most of India would celebrate the festival of Holi that day while Jeetu was struggling to survive. The next 5 days were crucial. Jeetu was administered ASV and other supporting medicines. We do not know the number of vials that were administered. Jeetu was also given 8 units of blood as there was excessive internal bleeding which is one of the symptoms of an untreated saw scaled viper bite. The area where Jeetu lived has a distribution of Echis carinatus sochureki (saw scaled viper).
Jeetu’s ordeal was finally coming to an end. He had not eaten much in the last 7 days and started consuming solid food only after his treatment started in the hospital. He had regular bowel movement only after 9 days from the bite.
Jeetu was discharged from the hospital on the 6th day with antibiotic medicines for the next 15 days. He was also given an antibiotic cream to be applied at the bite area. The swelling around the bite area finally went down in a month’s time.
The author moved on after this case but Jeetu’s miraculous survival was always at the back of her mind. She left a message with Jeetu’s uncle Timar Singh asking him to ask Jeetu to call her. And he did!
One Sunday afternoon, sometime in May 2016, the author got a call from an unknown number. The caller said he was the same boy from Rajasthan that she had helped save. The happiness of hearing the voice of the kid that we thought would not make it was unimaginable. While Jeetu spoke about his ordeal, his other aunt who was just a year older than him snatched the phone and asked the author, “Do you know what you have done for us?” There was complete silence as tears of joy flowed freely!
India experiences many cases of venomous snakebites where the victim’s family resorts to faith healing. In this particular case, Jeetu’s family didn’t know that a snakebite is treated at a hospital. Everyone in their village went to the local temple whenever a snakebite occurred.
Post this case, the author asked Jeetu and his young aunt to become proponents of snakebite awareness in their village and spread the word that only Snake anti-venom could save a venomous snakebite victim’s life.
Jeetu is now aspiring to join the Indian Army!
Written by Priyanka Kadam.
This is a story from Sahamsapur village nestled in Varanasi district of Uttar Pradesh. Bhola Rajbhar, 60, is a daily wage labourer. He has eight children and lives in a house with unplastered outer brick walls. The small area in front of the cluster of houses has a neem tree and a shed that houses a cow and four goats.
Around 8 a.m. on August 24, 2015, Bhola set out to cut grass for the cattle. He headed towards an area half a kilometer from his house which had wild grass and shrubs growing all over. This was during the monsoon season with grass growing up to a foot in height. In his hurry to gather as much fodder as he could, Bhola didn’t see a snake hidden in the grass. As he gathered a tuft of grass with his left hand, he was bitten by a Spectacled Cobra. He still couldn’t see the serpent and by the time he realized the presence of one, he was bitten 3 times on his hand.
Bhola ran home and informed his family about the bites. Fortunately, his third daughter, Geeta Kumari was at home. As a child, Geeta was struck by polio and left differently abled. This did not deter her from going to school. She had studied till class 12 in a high school nearby and aspired to earn her own living. Geeta knew that the only cure for a venomous snakebite was to go to a hospital. She dug her heels in when the others suggested going to a local faith healer. Geeta managed to convince her family and neighbors that they should take Bhola Rajbhar immediately to the Kachwa Christian Hospital, about 20 kms away for treatment.
Bhola Rajbhar was taken to the Kachwa Christian Hospital on a motor bike with one person driving and another holding him. By the time the trio reached the hospital, Bhola was experiencing signs of envenomation. He was experiencing hot flushes, had blurred vision and suffered respiratory distress.
Bhola was administered 10 vials immediately and kept in the hospital for 3 days. His index finger suffered necrosis and it took 2 months to heal. Total cost of treatment was Rs 9,000. Bhola had to travel to Kachwa Christian Hospital every two days in the initial stages for getting the necrotized wound dressed.
The burden of snakebite treatment was heavy on the family. Apart from losing livelihood till the time he healed, Bhola also had to sell a goat and use the money his daughter Geeta had saved from the dole she receives under a state government scheme to rehabilitate physically challenged people.
India is a country with the highest number of deaths due to snakebites. Many deaths occur due to people believing in faith healing as a cure for venomous snakebites. Bhola could have easily fallen victim and died if his family had taken him to a faith healer. The quick thinking of his daughter saved his life!
Written by Priyanka Kadam
This is the story of an unfortunate 10 year old boy, Imran S.K. Imran was the son of Moslem S.K., a poor farmer from Sikarpur village, under Bewa Gram Panchayat, Police Station & Block Farakka, District Murshidabad, West Bengal. He had 7 siblings and his father struggled to feed the family from the produce grown on the small tract of land he possessed. Imran was bitten by a venomous snake around 11 a.m. on 15th Oct 2015.
The family elders, being illiterate, resorted to faith healing by a local healer. When it became evident that the child’s condition was deteriorating, Imran’s father took him to the Beniyagram BPHC (Block Primary Health Centre). The staff there referred Imran (without treating him) to Dhuliyan Central Hospital (DCH) (a Central Govt Hospital for Bidi workers) at Tarapur, Shamsherganj, Dist Murshidabad. The child was brought to DCH 24 hours after the bite. His left foot had progressive swelling.
It was 10.30 a.m. 16th Oct 2015. Dr Saswati Naskar was the Medical Officer at DCH and attended to Imran in the OPD (Out Patient Department). She performed the 20WBCT (whole blood clotting time) test. The blood didn’t clot in 20 mins. This was a sign of a viper (hemotoxic) envenomation.
DCH is a hospital only for bidi workers. The general public is not treated there. The hospital also had no facility to treat snakebites. Dr Saswati further referred Imran to Jangipur sub-division hospital where Imran finally got his first dose of antivenom (10 vials) after almost 30 hours after the bite. Doctors at the Jangipur sub-division hospital further referred Imran to Murshidabad Medical College & Hospital at Berhampur, 40 KM from Jangipur. By this time Imran was heading towards renal failure. The hospital had a dialysis machine and conducts dialysis through the Public Private Partnership (PPP) with 10 beds kept for this purpose. Even though the facility was available at the hospital, the staff referred the patient to a Kolkatta hospital. The reason given was that the hospital didn’t have care facilities for children.
Moslem was asked to shift Imran at 10 p.m. in the night. Kolkata is approximately 200 kms away from the Murshidabad Medical College. Moslem SK did not have the finances to afford the trip and treatment. Heart broken, he decided to take his son back home.
Murshidabad is situated on the border of West Bengal and Jharkhand. There was a local faith healer in Talbehera village of Jharkhand. Frustrated at not getting treatment at the Govt hospitals, Moslem SK chose to take his son to this healer. It was evening of 17th Oct and Imran was by now very critical.
Meanwhile Dr Saswati Naskar from the DCH hospital was concerned about the boy not receiving proper treatment. She therefore brought this case to the notice of Dr Dayal Bandhu Majumdar who is the points person in West Bengal for Snakebite Management Training for doctors. Dr Dayal shared this information on the Snakebite Interest group on Whatsapp. This group has doctors, herpetologists and social workers working as a team to mitigate snakebite. Soumya Sengupta, a teacher from Bankura, West Bengal picked up the information and started following up with Imran’s family. Soumya collected the contact number of the BDO (Block Development Officer) of the Farakka Block and requested him to intervene. Dr Saswati called Imran’s family a couple of times as well. The stress of a child being critically ill and people repeatedly calling the family made the family provide wrong status of Imran’s health. In the meantime, the WhatsApp group made all arrangement at NRS Medical College, Kolkata for treatment of Imran.
Priyanka Kadam who runs Snakebite Healing and Education Society got involved at this point and Soumya and she started repeatedly calling Imran’s father to coax him to take the child back to the hospital. Imran was showing signs of renal failure with progressive swelling. By midnight, Imran breathed his last and he was buried as per Muslim custom in the early hours of 18th Oct 2015.
Priyanka called Moslem’s phone at 8 a.m. on 18th Oct and was informed by a relative about the boy’s death. It was a huge failure of the medical system to see a patient being taken out of hospital and back to a faith healer. A poor farmer had lost his child after running to 4 different hospitals in search of treatment.
The State of West Bengal gives Rs 1 lakh as ex gratia payment to the family of a dead snakebite victim (W B Govt Order No. 1561, Dated: 19.8.2009).
However, in this case, no death certificate was issued and no post mortem was conducted. Imran’s family had not even informed the local police of his death due to snakebite.
The Joint Secretary to the Government of West Bengal vide order number 1561 (19) F.R/4P-3/04 dated 19.08.2008, had waived off Post Mortem report for payment of ex-Gratia in case of death due to snakebite. Armed with this order, Priyanka approached the village Pradhan, Smt Munni and the BDO of Farraka to order a police investigation on the cause of death of Imran S.K. and use the report as supporting evidence to waive requirement of post mortem report to apply for an ex gratia payment to Imran’s impoverished family. Imran’s father was afraid the authorities would exhume his son’s body. He therefore avoided any official interference.
It took many calls to motivate the people on the ground to help with filing the request for ex-gratia payment. The application was filed in Nov 2015 and finally came through in June 2016. The collective efforts of Dr Saswati Naskar, Dr Dayal Bandhu Majumdar, Soumya Sengupta and Priyanka Kadam ensured the distraught family got some relief from their debt ridden existence.
This is a small victory against the challenges that the snakebite mitigation issues face regularly at multiple levels. Unless the Health & Welfare Ministry recognizes this as a tropical disease with a serious health care concern, many more Imrans will die of a condition that could be easily treated at a BPHC (Block Public Health Center) level where treatment is available free of cost for all in WB.
To sum up, a simple calculation may encourage Government officials to feel the importance of “Treating a Snakebite case at a BPHC level” – ten vials of ASV, which costs five thousand rupees at Govt rates, at Beniyagram BPHC could have saved the Govt Rs One Lakh which was given as ex-gratia payment. Most importantly, a precious life got snuffed leaving the victim’s family distraught.
The efforts of all concerned in this story is to ensure a timely treatment of all snakebite victims. We aspire for a stage when no one has to claim ex-gratia for a dead family member.
Written by Priyanka Kadam (with inputs from Dr Saswati, Dr Dayal Bandhu Majumdar and Soumya Sengupta).
This story is of a little boy called Prince Yadav from Bihara Village in Gazipur district of Uttar Pradesh. Bihara is one of those impoverished villages in India which has no electricity. The main occupation of the villagers is farming and animal husbandry. The village is surrounded by fields where crops like paddy, mustard, Tur dal, flaxseed and various kinds of seasonal vegetables grow.
The villagers live in joint families and hence each family has more than 20 people living together. The little boy in this story has been living with his grandmother and aunts while his mother lives with her parents in another district.
It was 9 a.m. in the morning of the 5th of Nov 2015 – a winter day. Two-year-old Prince was playing in the mud next to their house. The brick and mortar house is surrounded from three sides by mustard fields. Prince was digging a hole close to the wall of the house. As he dug deeper, he unearthed a hole. Being curious he inserted his right hand inside and something bit him. He shook his hand and again put it inside the hole. He was bitten once again. Seeing him cry, his family rushed to his side. They saw his hand bleeding due to multiple punctures. No one saw the snake!
Looking at distinctive puncture marks, the family tied a tourniquet on his forearm. His hand started swelling within 5 minutes of the bites. In a few minutes, he started frothing and lost consciousness. Fortunately Prince’s family did not waste time in faith healing. Kachwa Christian Hospital is 9 kms away from Bihara Village. It took approx. 90 minutes for the family to reach KCH. Prince was immediately admitted and intubated. The doctors at KCH personally monitored Prince until he was out of the woods.
Prince was administered 14 vials over a period of 2 days. He developed high fever on the 2nd day of the admission. He was under the careful supervision of the resident doctors who prescribed antibiotics and other supportive drugs. The child was discharged on the 5th day of the bite.
The nurses who took care of Prince speak about his naughtiness even while ill and suffering from the effects of a venomous snake bite.
Over the next few days, Prince’s hand developed severe necrosis. It took almost 4 months for the hand to heal. The author met the child in Feb 2016. The third finger on his right hand is bent and painful. While he does not allow anyone to straighten his finger, Prince will need regular physiotherapy to get the digit functional. The total cost of treatment was ₹ 13,000.
As per the treating doctors, the envenomation signs & symptoms in this case pointed to a Cobra bite.
Written by Priyanka Kadam.
Dinkar Prasad Singh, a 55-year-old is a farmer from Baraini Village in the Mirzapur district of Uttar Pradesh. He belongs to the Yadav community and has his own farm land and a few Jersey cows and other cattle. He is a heavy, obese man and weighs 106 kg. His family grows wheat and bajra (pearl millet) in their fields. He has 4 grown up children.
Bite incident: 13th June 2015. Dinkar and his sons were in a room that had beds spread across the room from wall to wall. At around 1.15 a.m. he felt a sharp pain on his left foot. He got up with a start and realized a cobra was biting him. The snake had to be yanked away. The family panicked. Dinkar was taken to the hospital on a motorcycle. As they were in a rush to take Dinkar to the hospital, they forgot about the snake.
It took around 30 minutes to reach Kachwa Christian hospital. By that time Dinkar’s vision had blurred and he had lost consciousness. The resident doctor, Dr Takemba Ao attended to this patient. At the time of the admission, he was GCS 3/15 – a condition in which only his heart was functioning. There were no other signs of life. Due to Dinkar’s obesity, it was difficult to intubate him. Dr Ao immediately put him on life support and started the first dose of ASV.
Dinkar regained consciousness only on the 5th day of the bite. However, he still needed respiratory support for another 3 days. Necrosis had set in on the local area from the 2nd day of the bite. Tissue damage was severe and spread to the dorsum of his foot. On the 9th day, he was taken off the respiratory support. He received a total of 23 vials of ASV. He was discharged after 18 days. He was later referred to BHU in Varanasi for further treatment of the necrotized area. The wound had festered and chances were his foot could be amputated. The wound needed expert management to ensure his didn’t suffer morbidity. Even today, 8 months after the bite, he does not have sensation on his foot and his left hand has a frozen arm syndrome. Total cost of treatment was Rs 2.5 lakhs (Rs 2,50,000)
What happened on the 19th day of the bite
On the night of the 19th day, a day after Dinkar was discharged from the hospital, he was sleeping on the same bed as on the night of the bite. The room was pitch dark. Around 1 a.m. Dinkar and his sons were awakened by a hissing sound. When they switched on the light, a spectacled cobra with its hood spread was seen right in front of the bed. We are not sure if it was the same snake that had bitten Dinkar. In a fit of rage, Gaurav, Dinkar’s 19-year-old son, chopped the snake in 2 pieces using spear like weapons they kept at home to ward off wild animals raiding the fields and also to guard against dacoity which is rampant in the region.
Deep seated beliefs in dogmas regarding snakes had made the family perform pujas etc. to ward off the curse (it’s a common belief in India that snakebite is a curse by the snake god). The author inspected Dinkar’s house and provided inputs on the changes that the family should make to guard against untoward incidences like snakebites. The room where the family slept had sacks of grains, a pot filled with water and miscellaneous items packed into it along with wall-to-wall beds. This was a perfect habitat for rodents. The gap between the house wall and the roof was almost 6 inches. This gap was not meshed and gave snakes and other animals easy access to the interior of the house. The author provided guidance on snakebite management and how to avoid being bitten in the first place.
To know more about snakebite management, do follow the below mentioned link
Written by Priyanka Kadam
Rama Shankar was a 50-year-old carpet weaver from Mahamalpur Pipariya Village in the Mirzapur district of Uttar Pradesh. His monthly income was a meagre Rs1500. He had 4 daughters and a son. His wife Umavati did odd jobs in the village to support the family. They lived in a mud house, cooked on dry wood collected from the nearby forest and did not have an enclosed latrine in their house.
One day in Sept 2013, Rama Shankar went out in the wee hours to answer nature’s call in the nearby fields. He accidentally stepped on the tail of a Cobra that hooded up and bit him just above his left knee. Rama Shankar rushed back home and informed his family about the incident.
The impoverished family, which led a hand to mouth existence, had no money for treatment. Rama Shankar was nevertheless taken to the village faith healer who gave him a herbal concoction and bathed him with copious amounts of water. Rama Shankar’s condition seemed to get worse and the family brought him back as they had no more money for treatment.
In the next few days, Rama Shankar’s condition deteriorated even further. A local leader of the village shared that Rama Shankar’s condition was suggestive of profound brain damage and pneumonia. He died on the night of the 10th day of the bite. The family didn’t have enough money even for his funeral and their neighbors helped by contributing money so that Rama Shankar’s body could be cremated.
After Rama Shankar’s death, the condition of his family further worsened. Today, Umavati struggles to feed and clothe her family. Two of her daughters are of marriageable age. None of her children go to school. The youngest daughter, seen in the picture along with Umavati, has attended primary school but does not know to read and write.
Snakebite is a treatable condition and as per the provisions in our constitution – Right to Life (Article 21) and Right to Avail Basic Health Care (Article 41)- Rama Shankar should have been provided free treatment and survived. The truth, however, is that such provisions are present in letter only with gross misuse in implementation at the ground level. Since most victims of snake bite are from the poorer sections of society hundreds of deaths due to snakebite go unchallenged and unreported every year.
Rama Shankar’s death has not been recorded as the family didn’t go to a hospital nor did they inform the local police station. This is common in rural India where hundreds of victims from impoverished backgrounds do not report to the hospital for treatment. A large part of the rural population has faith in dogmas and faith healing. This, coupled with high cost of snakebite treatment at hospitals, ensures that the victim’s family continues to depend on faith healers and traditional methods.
There is no method of correctly determining the exact number of unreported deaths due to snakebites in rural India. The data regarding the death of Rama Shankar, and of thousands of his rural brethren across India, are lost forever. Snakebite affects mostly the poorer sections of society and hence does not get priority in the health policies of almost all Indian states. Lack of data regarding deaths & morbidity related to snakebites has made it easy for the government to sweep any concern under the carpet citing not enough deaths to treat this challenge with urgency.
The effect of losing a member due to snakebite on a family living below the poverty line is crushing. The family has to invariably take a loan from the local money lender and then has no option but to enter into bonded labour in order to pay off the debt. Many children are orphaned and left to fend for themselves as relatives do not want to take the responsibility of bringing them up. Also, most states do not have any compensation plan for snakebite deaths. Considering our very high population and the healthy distribution of venomous snakes across India, these deaths due to snakebite are a cause of grave concern. Citizens living below the poverty line have a right to life too.
Snakebite Healing and Education Society, through its endeavor intends to document stories of such cases from across India to demonstrate the severity of the situation and the need to look at this issue afresh.
Written by Priyanka Kadam
This is the story of Varjanbhai Alabhai Kadachha, a 40 year old primary school teacher. Along with his day job as a teacher, Varjanbhai is also a farmer and the family owns a flour mill. Varhanbhai is married and has three children. The family lives in Kadachha village in the Porbandar district of Gujarat. Kadachha is around 13kms from Madhavpur (Ghed) where Arun Bhai Devani is based and 35 kms from Mangrol where the Govt hospital is situated.
Bite Incident: On the 12th of Dec 2008 around 5 p.m. in the evening Varjanbhai was manning the flour mill to grind wheat, millets and pulses that the villagers had deposited at his shop. The flour mill was a square shaped structure built out of huge rocks with open gaps.
In the middle of the room stood the grain grinder machine. Depending on what is being grinded, the machine needs to be adjusted to refine the flour. A Spectacled Cobra had taken refuge in one of the bigger crevices in the wall close to the machine where the refinement button was located. Varjanbhai bent to adjust the knob and was immediately struck on the inner ear lobe by the startled cobra.
The pain was excruciating. Varjanbhai did not see the snake. The ear was bleeding profusely by this time. Varjanbhai was sure it was a snake bite and asked a few people to take him to the village doctor. Varjanbhai reached the doctor’s clinic in 20 minutes from the time he was bitten.
In no time Varjanbhai started experiencing neurotoxic envenomation signs – ptosis accompanied by blurred vision and vomiting. Varjanbhai was finding it difficult to even move his hands. The doctor immediately called Arunbhai Devani, a local snake rescuer who had much experience of treating snake bites.
For the last 10 years, Arunbhai has been assisting Dr Makwana in Mangrol Govt Hospital and Dr Ashwin Vanza in Krishna Health Centre in Madhavpur and has successfully treated hundreds of snakebite cases. He is therefore considered to be the local expert and called by the locals in a snakebite situation. Arunbhai called the 108 emergency ambulance services to transport the victim to the Govt hospital in Mangrol.
Meanwhile the victim’s friends asked him to chew some neem leaves and enquired whether he could feel the bitter taste of the leaves. Varjanbhai informed them that he could not.
The 108 ambulance arrived in 15 minutes and the victim was transported to Mangrole Govt Hospital. It took the patient party about 40 minutes to reach Mangrole. The paramedics realized that the victim was getting critical with each passing minute and with guidance from their call centre located in Ahmedabad, they administered 8 vials of anti-snake venom (ASV) along with supportive drugs during the travel time from Kadachha to Mangrole.
On arrival at the Mangrole Govt Hospital, another 20 vials of ASV was infused. By this time the victim was entering respiratory distress and his breathing tract was cleaned with a suction machine. With assisted breathing, the patient was stabilized by 8.30pm.
By around 11 p.m. the patient revived enough to have some tea. Varjanbhai was given a total of 32 vials of ASV and discharged the next day at 9 a.m. The local bite area was dressed for the next two days by Arunbhai. Within 3 days, Varjanbhai resumed work. The total cost of treatment in this case was Rs 16,000.
This story is typical of the exigency that accompanies a venomous snakebite in India. Varjanbhai was lucky to have all the elements in his favour and hence survived. The absence of good local conveyance facilities in remote areas of India coupled with the lack of first aid and preliminary treatment ensures that the chances of survival of venomous snakebite victims is almost nil.
Written by Priyanka Kadam.
This story is from Dhanyaha village, PO Ilahipur, District Hooghly in West Bengal. Dhanyaha is a non-descript village having houses that are bunched together surrounded by fields from all sides. The houses are built of cement, mud and bricks. The outer wall of every house has cow dung cakes pasted on it to be dried and later used as fuel.
Haradhan Ghorui, a 48 year old farmer lives with his large family which is supported by a small tract of land and some cattle. On 27th August 2015, as per routine, he went to work in his field at around 9.30 a.m. The paddy was growing well. Haradhan proceeded to clean the weeds that had lodged itself on the periphery of the field. A small section needed some ploughing and while he was doing this, accidently put his foot into a puddle. Something bit him and when he lifted his leg, Haradhan was horrified to see a Russell’s viper attached to his foot. He yanked the viper from his leg and thought this was the end of his life. He would die very soon.
This thought made him angry and vengeful. He used a small cloth that was swung around his shoulders to capture the snake and bit the snake across its body in three different places. The vicious attack had the snake’s intestines spilling all over. He then bundled the snake and returned home with the snake in tow.
When he narrated the incident to his family, they immediately took him to Singur Rural Hospital. The doctors examined him and since there were no signs of envenomation, Haradhan was given a tetanus injection and admitted in the hospital for further symptom and investigation.
The snake died a day after it got injured and was packed into a polythene bag.
The doctors on the ground consistently conducted the 20WBCT test to ascertain the clotting effect and urine test to check the creatinine and urea levels (which is found to be high in a viper bite scenario). This test was repeated 4 times every day and each time the result was negative. Haradhan was kept in the hospital for the entire week and discharged on the 7th day of the bite. Apparently he had suffered a dry bite. A situation wherein the snake bites but does not inject venom into the victim’s body. Haradhan was asked to report to the hospital in 2 days which he did. The total cost of treatment was Rs1500.
The author met Haradhan on the 13th day of the bite. While narrating the incident, Haradhan mentioned that he was saved as he had bitten the snake and killed it. The victim in fact was lucky by chance! He could have been bitten by the snake when it was being attacked.
A majority of people in rural India are semi-literate and have grown-up conditioned with myths regarding snakes.. In this backdrop, while it is heartening to see that Haradhan survived a bite from a highly venomous snake, his survival can easily get linked to countering a venomous snakebite by biting the snake back. Such incidents therefore need to be monitored and victims counselled on the real reason for their survival.
A myth that takes root is difficult to dispel. The more people volunteer to spread awareness about snakebites in their communities, the more are the chances of survival…for humans and snakes!
Written by Priyanka Kadam
This story is from Kalasa town in the Mudegera Taluka, Chikmagalur Dictrict in Karnataka. A man had died of a King Cobra bite in Chikmagalur, Karnataka. This was a first for me as the King is an otherwise non-combative snake and prefers to flee than to stand its ground and attack. The incident happened on 22nd Sept 2015 (3 days ago) at around 2pm. By 23rd Sept 2015 the pictures were making the rounds on social media. I received the bite related pictures from 3 sources but no one knew who the affected victim was or the background to this incident. With much help from Oumkar Umesh, a special correspondent with Samaya TV, the author was able to document this incident by contacting the plantation owner who had called the victim, Prafulla Bhat, a local snake rescuer to re-locate the snake.
Background of the victim: Prafulla Bhat, a 67 year old rescuer, belonged to an affluent family in Kalasa town. The family owned tracts of land for farming and also shops selling various goods from jewellery to clothes to perishable goods. Prafulla Bhat had been rescuing snakes for the last 30 years and indulged in free handling. This hobby had made him a household name in the area.
Bite Incident: A King Cobra was spotted in an estate in the Kalakodu area at around 1 p.m. on 22nd Sept 2015. Kalakodu is around 10 kms from the Kalasa town. The snake was resting in the coffee plantation section of the estate. The estate was spread over 60 acres of land divided into three parts and had areca nut, pepper, cardamom and coffee plantation in different sections.
September to November is the time for pruning and cleaning of the vegetation in preparation of the harvesting season that lasts from December to February. King Cobras are generally sighted on the estate 2-3 times a year as they stray from the neighbouring Kudremukh forest reserve. The terrain is forested and hilly and a lone stream flows through the Kalakodu estate. During summers, this water body attracts wild life from the reserve.
Generally the King is left alone but this time the sighting was quiet close to the staff quarters. Mr Dhanaresh, the plantation owner, was concerned that unwanted man-animal conflict may occur and hence decided to get the snake relocated.
Prafulla Bhat was informed about the resting snake around 1.30pm and he came to the site in less than 30 minutes. The snake was lying in a straight line. It was captured in 5 minutes flat and Prafulla Bhat started walking towards the staff quarters with the snake’s head held in one hand.. He covered the 100 meters with the snake in his hand. The snake had been in the deathly grip for a long spell and stressed. The plantation carpenter and other workers gathered around Prafulla Bhat and the snake to take pictures.
A split second of distraction was enough to spell disaster. Prafulla Bhat held the snake’s head in his left hand and moved his right hand at a biting distance from the snake’s mouth. The king immediately bit Prafulla Bhat on his right hand palm. Prafulla Bhat asked for water and lemon to clean his wound. The snake was still locked in his left hand. Within 5 mins of the bite, the snake wriggled free from Prafulla Bhat’s grip and coiled itself around his fallen body biting him twice on the back and making loud hissing sounds to warn the spectators to keep away.
Mr Dhanaresh, who had just returned after parking his car, immediately sprung into action. He ran and brought a PVC pipe from the godown nearby and while the snake was hissing loudly, shoved the pipe towards its face. All that the by now stressed out snake wanted was to escape. It immediately went inside the pipe. The pipe was secured from both the sides and Prafulla Bhat’s body dragged away to be taken to the hospital.
Prafulla Bhat’s lifeless body had been retrieved within 5-7 minutes of the bite incident and put in the car to be taken to Prabhu Clinic, a private hospital in Kalasa. Dr Vishwanath Prabhu was a close family friend of the Bhats. The rescue party along with Prafulla Bhat reached the hospital within 10 minutes.
Mr Dharanesh, the plantation owner who took the victim to the hospital in his car shared that Prafulla Bhat could have been dead within 10 minutes of the bite as there was no movement in his body while they were transporting him to the hospital. After being declared dead, the victims’s kith and kin lodged a police complaint and took the body to the Govt. hospital in Kalasa. He was again declared dead by Dr Manasa who managed the post mortem and other formalities after which the body of the deceased was handed over to the family at 4.30 p,m.
Meanwhile the snake was later handed over to the Forest department to be released in the forest reserve nearby.
Praffula Bhat’s wife was away in Udipi. The family waited for her to arrive and he was cremated in the wee hours of 23rd Sept 2015. This was perhaps the second serious bite Prafulla Bhat had suffered in his life time. The earlier one around 6 years ago was another venomous snake bite that festered and he had to be treated at the Manipal Hospital in Karnataka for almost 45 days.
This story has an unfortunate ending wherein a rescuer lost his life. Prafulla Bhat had rescued around 10-12 King Cobras in this season and his risk taking ability got the better of him.
A few thumb rules for rescuers rescuing venomous snakes:
1. Never touch the snake with bare hands. Use snake handling equipment.
2. No showmanship during rescue and release.
3. No engagement with the on looking crowd which can hamper concentration levels.
4. A small awareness talk can be done with the on looking spectators after bagging and safely putting away the snake.
5. Know the distribution of venomous snakes in your area and be aware of the species and their behaviour before embarking on rescues.
6. Do not encourage unnecessary handling.
7. Never risk your life to catch the snake.
Snakebite Healing and Education Society has documented this story through inputs from Mr Dharanesh KC, The plantation owner and Mr Oumkar Umesh, a special correspondent with Samaya TV. The pictures used in this story are images clicked by the plantation staff.
Written by Priyanka Kadam.
I was looking forward to my trip to Madhavpur (Ghed) in the Porbandar district of Gujarat. I had been exchanging notes with Arun Bhai who is the local expert treating snakebites at Krishna Health Centre under the supervision of Dr Ashwin Vanza. Arun Bhai has been a snake rescuer for 40 years and has been medically treating snakebites for the last 10 years. He is now quite famous in the region and in a snakebite situation most people call him first before calling the 108 ambulance services.
Arun Bhai had shared details of a Russell’s viper bite victim who had got admitted two days before I reached Madhavpur Ghed. Santokben Navghan Kadachha aged 45 years and mother of two grown up children had gone to cut grass to be used as fodder for the cow. That fateful morning she had cooked food for the family, milked the cow and then around 9 a.m. set out to cut grass from a spot about half a km away. The grass was overgrown and she didn’t see the adult 1.5 ft long Russell’s viper lurking in the grass. As she gathered a clump of grass with her left hand the snake bit her on the thumb.
Santokben walked back home. The house was empty as her husband and son were out on work. The neighbours helped her board an open rickshaw to be transported to Krishna Health Centre in Madhavpur Ghed where Arun Bhai treats snakebite victims.
Kadachha village is about 13 kms away from Madhavpur Ghed. Santokben managed to reach Madhavpur almost 45 minutes after the bite. Arun Bhai administered 2 vials of ASV as she was experiencing intense pain in the local area. The 20 BTCT (Bleeding time clotting time) test was fine.
Despite being in stress about the bite, what worried Santokben the most was her beloved cow. The Kadachha community treat their cattle as family. The bovine didn’t allow anyone except Santokben to milk her. Who would milk the cow? And if the cow was not milked, her teats would engorge making the animal terribly sick.
Santokben experienced local area swelling and pain. However the BTCT tests done on intervals of 2 hours didn’t show signs of envenomation. This was due to the ASV being administered immediately; before the venom got a chance to attach itself to vital organs. After no symptoms of anti-coagulation in repeated tests conducted at regular intervals, Santokben was discharged around 4pm, a good seven hours after the fateful bite.
Santokben developed considerable amount of swelling on her left hand. On day two after the full blown swelling manifested, Arun Bhai treated the condition by applying a mix of Magnesium Sulphate and glycerine bandage. The author met the victim on the 3rd day of the bite. It was difficult to imagine she had been bitten on her thumb as there were no tell-tale bite marks. Santokben was administered 3 sittings of Magnesium Sulphate bandage and the arm came back to its ordinary shape in a matter of 4 days.
Timely treatment and absence of use of tourniquet ensured Santokben didn’t suffer local area necrosis or other symptoms of envenomation which can result in renal failure in a viper bite.
Written by Priyanka Kadam.
This true incident happened in July 2009 in Mander village, PO Madhavpur, District Porbandar, Gujarat. The total population of Mander is less than five thousand.
Valiben Parmar was 33 years old then and already a grandmother. Her daughter Devi ben had just delivered a baby and was staying with them for a few weeks. It was around 3.30 p.m. and Vali ben had just finished washing clothes. She took the washed clothes to hang on the clothes line which was tied to the outer wall of the house.
In most houses in the village, the walls are built with merely bricks or lime stones with no plaster to cover the crevices between adjacent bricks or stones. This provides shelter for snakes, lizards and other insects to reside. As Valiben was hanging the clothes, she felt a sudden, sharp pain in the big toe of her right leg. A cobra that was in one of the holes had latched on to her big toe thinking it was prey. Valiben tried to shake off the snake but it wouldn’t let go of her toe. She had to pull the snake off her toe. Stunned by this sudden attack, Valiben rushed indoors to her daughter. There were no male members at home. Both the women started calling out to their neighbours for help.
The neighbours, seeing that it was an emergency case, rushed to the center of the village where Valiben’s husband, Rammal bhai had gone on some errand. On hearing of the snakebite, Rammalbhai rushed home and along with the neighbours, carried Valiben to an open rickshaw to be transported to the main road where the 108 ambulance service would pick them up. A tourniquet was tied to Valiben’s leg a little below the knee. 30 mins had passed since the bite and Valiben was already showing signs of envenomation. By this time word had spread and the entire village had turned out to help in whichever way possible.
It had rained very heavily during the past few days and the entire area was water logged for miles at a stretch. In many places the water level was higher than 5 feet and had completely submerged the roads. There was no way to ascertain the two sides of the road. The fields were situated at least 3 feet below the roads on both sides. It was therefore dangerous to try driving through the water. Moreover, the small rickshaw would just not be able to move through water of this depth.
Incidentally, the owner of a goods carrier truck was stranded in the village due to heavy flooding. The truck driver offered to help transport Valiben to a higher area where she could be transported to a waiting ambulance. This gesture was a big relief to Valiben’s family but this was only the beginning of the ordeal to get her to the hospital at the earliest possible.
Laxmanbhai, Valiben’s brother in law, was a good swimmer. He volunteered to swim in front of the truck to guide the driver and thus ensure that they were driving on the road. It was a perilous task. The driver deflated the six tyres and loaded heavy rocks in the truck to stabilize the vehicle in deep water. They then put Valiben on a charpoy (bed made of four legs and jute ropes) and loaded her on the stones. This was done to ensure Valiben did not experience bumps and jerks while being transported.
The rescue party had called the 108 ambulance services and it was waiting for Valiben on the highway close to Mocha village. By the time they were able to reach the ambulance, 1.5 hours had passed and Valiben was almost unconscious. She described her trance-like experience in detail. She could see nothing. She could just hear very faint voices of people around her. Valiben was immediately administered oxygen and ASV by the paramedics. The tourniquet was removed in the ambulance itself. The ambulance proceeded to pick Arun Bhai who was a local snakebite healer with much experience. The group proceeded to Mangrol where the govt hospital was situated. They reached Mangrol at 6 p.m. A good 2.5 hours after the bite incident.
A total of 40 vials of anti-snake venom was administered as the victim was in a serious condition. Valiben’s vital signs stabilized in 24 hours and she was discharged the next day. The total cost of treatment and hospitalization was Rs. 15,000. Valiben was extremely weak with pain in her leg and had to be carried back home.
By this time it had rained some more and Valiben’s village, Mander, was flooded even more than when they had set-out for the hospital. There was no choice but to take shelter in a relative’s home at Chingariya Village. Valiben had to stay there for the next 8 days until the rain stopped and the waters receded.
Arun Bhai, the local healer visited Valiben every single day post her discharge from the hospital to dress the growing necrosis that was festering her feet. For 2 months Arun Bhai visited Valiben every alternate day to dress her wounds. The spreading necrosis was an appalling sight and Arun Bhai didn’t allow Valiben to see her feet in that condition. His approach is to keep the patients assured that they were fine and going to make a full recovery.
It took six months for Valiben’s leg to completely heal. She has deep scars, a reminder of the fateful incident that nearly took her life. The family have not changed their belief in worshipping snakes and do not kill them whenever they come across one on their farm.
This story addresses a snakebite victim’s ordeal for survival in rural Gujarat; there are many people who emerged heroes on that day because of whom it was possible to transport Valiben to the hospital. Two such people were Valiben’s brother in law, Laxmanbhai who swam guiding the vehicle and, most importantly, the truck driver who took the risk of damaging the truck’s wheels (each pair of tyres costs Rs 25,000) and engine in the deep waters. The entire community had swung into action on that fateful day and made it possible to save a lady who otherwise would have died.
Written by Priyanka Kadam.
Arun C Devani’s profile:
Arun Bhai is a snakebite healer who medically treats patients under the guidance of local doctors. He has more than 35 years of experience as a snake rescuer. In his younger days, Arun Bhai used to travel across the state of Gujarat conducting workshops on snake awareness. His vast experience of handling snakes and snakebites has made him something of an authority on snakebite treatment and even the local doctors respect his expertise. Snakebite Healing and Education Society intends to work with Arun Bhai on capacity building of the area and has documented victim stories of faith, accurate diagnosis and survival.
Fenil Virendra Dhedia is a 20 year old B.com graduate living in Borivli, Mumbai. He is the youngest amongst his siblings. Following his father’s footsteps, Fenil works in a garment shop that sells children’s wear.
Bite incident: Every year Fenil’s employer takes his staff for an annual outing. On 25th June 2015, thirteen staff members were taken to The Great Escape, a resort situated 20 kms from Virar station on the outskirts of Mumbai. The property is situated in a scenic backdrop with boundary walls on three sides and one side open to the outgrowth that spreads into the valley below.
The resort has 2 swimming pools with water slides and games. That day Fenil had been in the pool for a while and was crossing over to go to the other side. Right on the cobbled ground a juvenile Russell’s viper was also crossing the path. Fenil stepped on the little snake and in a reflex action it bit him on the big toe. It was like an ant bite at the beginning. The resort’s staff caught the snake and was proceeding to relocate it when they were told about the bite incident.
The staff asked Fenil’s employer to immediately rush him to a hospital. The group went to a health centre nearby and Fenil was administered a tetanus and pain killer injections. He was then taken to the Shatabdi Hospital situated between Borivli and Kandivli stations. The snake was bottled and taken along for identification purposes.
The bite incident had occurred at 3 p.m. and Fenil was admitted to Shatabdi Hospital after 2 hours.
Thanks to the world of social media, news about Fenil’s unfortunate encounter spread like wild fire within the snake rescuer community via Whatsapp.
In faraway Beed District, Sarpmitra Amit Bhagat, from Maharashtra Police had been bitten by a bamboo pit viper just two days ago and the author had helped him with details of doctors for consultation purposes. He was lucky it was a dry bite. The memory of the bite was fresh in his mind and when he read about Fenil on Whatsapp, he immediately contacted the author. It was around 6.45pm.
We quickly swung into action, got in touch with Mr Virendra Dedhia, Fenil’s father. We reassured him about his son being in safe hands and also presented the facts about his being bitten by a highly venomous snake. Fenil was complaining of severe pain in the leg and abdomen. He was administered 15 vials of antivenom. Mr Virendra wanted to shift Fenil to another hospital but was advised to not do so as the hospital had the necessary facilities in case of an emergency.
A CT Scan of the abdomen was done on 26th June at 4 a.m.. Fenil remained in the hospital for the next 5 days.
Fenil was extremely lucky to have suffered no tissue damage in the local area. The venom of the Russell’s viper has a hemotoxic effect on its victim. This means there could be internal bleeding and haemorrhage accompanied by intense pain and local area necrosis. But in Fenil’s case, there was minor swelling in the local area that remained for 2 days and then subsided.
The author kept in touch with the victim’s father inquiring about his well-being. Fenil was discharged from the hospital after 5 days. Within 10 days of the bite, Fenil resumed work and suffers no after effects of a venomous snake bite. He has been advised by the doctor to wear cotton socks for a few days.
Today is the thirtieth day since Fenil was bitten by the juvenile Russell’s viper. As we type this story, Fenil is enjoying a movie with his friends.
Written by Priyanka Kadam
4 year old Mohit was playing with two of his friends outside their house. It was 7.30 p.m. and almost dark with lights from the various houses and street lamps illuminating the narrow road. Suddenly Mohit ran home to his mother crying in pain. On inquiry he replied something had bitten him.
This is the story of Mohit Rajendra Yadav. He originally belongs to Aamdhari Village in Chapra District of Bihar. His parents had migrated to Mamsa near Bhavnagar, Gujarat in search of a livelihood. Mohit is the youngest child with two elder siblings. Mohit’s father works in an iron foundry. His mother is a home maker.
Bite incident: On 24th May 2015, Mohit came home crying and reported something had bitten him. Since no one had seen the snake, his parents thought he was either stung by a scorpion or bitten by an insect. When everything else failed to pacify him and the bite area began to swell, the parents suspected snake bite. They then rushed to a local faith healer. By this time Mohit began to vomit and defecated once. He was slowly losing consciousness and when his frail body started turning lifeless, his parents decided to rush him to Taktshihji Bhavshihji, a Government hospital in Bhavnagar. It was 9.30pm.
On arrival, the child was in a critical state. Looking at the child’s condition, the hospital staff asked the parents to file a report with the police stationed at the hospital. Precious time had been lost! Mohit was put on life support and administered anti-venom. He had all symptoms of a neurotoxic bite. A point to note is that the area where the family live has a distribution of Spectacled Cobra.
This case was brought to the attention of the author on the 3rd day of the bite. Mohit was administered 25 vials of Anti venom. He was still on life support. The local bite area had developed some necrosis but under control. A local student who is also a snake rescuer reported this incident. Since Snakebite Healing and Education Society (SHE) documents snakebite victim stories, we waited for the child to get better before publishing the same.
After 4 days, the author inquired about Mohit’s condition. It was then that she was told that Mohit was still in coma. He had been weaned away from life support and anti-venom was discontinued after his condition stabilized. However the child didn’t gain consciousness. It was 31st May 2015, a good 7 days after the bite had occurred.
Something was not quite right. The author immediately reached out to the resident doctor, Dr Chirag who was unwilling to discuss the case with a stranger and understandably so. Dr Chirag suggested I talk to his boss, Dr Mehul Gosavi, Associate Prof. It was late and hence the author contacted Dr Gosavi the morning of 1st June 2015. During the conversation with Dr Gosavi, the author was given to understand that the child had suffered hypoxia insult to the brain. The doctors had performed an MRI and the results were discouraging. The author suggested Dr Gosavi consult a few snakebite expert doctors who were associated as advisors with Snakebite Healing and Education Society. In the medical fraternity, it is common practice for specialist doctors to discuss and opine on complex cases.
The author shared details of four doctors and tried convincing Dr Gosavi to call them. However on each count Dr Gosavi claimed to be busy and hence the consultation never happened. By now another 4 days had elapsed and on Friday, 5th June 2015, the author urgently began to request Dr Gosavi to share Mohit’s medical report to enable her to reach out to the concerned doctors herself. In the meantime, on the same day, the author also reached out to six snakebite specialist doctors providing as much information as she could. The doctors agreed it was a serious case with irreversible brain damage. But they also agreed to be consulted by Dr Gosavi. On Saturday morning, Dr Gosavi texted that he was proceeding for a conference and shall share the reports on Monday, 8th June 2015. Despite the authors genuine coaxing, Dr Gosavi didn’t share any further details.
Sixteen precious days had elapsed and the author was getting desperate. She called Dr Chirag and reminded him of the Hippocratic Oath that all doctors took while in medical college and chided him for not sharing basic details that could perhaps help the doctors advise on the child’s treatment. Here’s the link for better understanding of the Hippocratic Oath that all doctors take to save life and limb at all cost. https://en.wikipedia.org/wiki/Hippocratic_Oath.
Dr Chirag then shared the Glasgow Coma Scale (GCS) score (which was 8/15) and verbally mentioned that the MRI finding was hypoxic ischemic insult. He however called the author and also mentioned that if they needed assistance, they would get in touch. It was a refined way of saying “buzz off”.
The author approached another advisor to the SHE initiative, who is a Supreme Court attorney. She in turn got in touch with the Indian Medical Association (IMA) and they promised to speak to the doctors on the ground as consulting on serious cases was an ethical code of conduct. Another 3 days elapsed and Team Snakebite Healing and Education society decided to write to Dr Pramod Jha, the Dean of Taktshihji Bhavshihji Hospital and Dr Gosavi. Dr Gosavi immediately replied to the email communication, that the patient’s condition was under control and he was being given the best of treatment. He refused to share any further details with us.
As a team we agreed that this was a gross violation of human rights (Article 21 – right to life). A young child was battling for his life while the doctors dug their heels on the ground.
SHE reached out to the Gujarat Chief Minister, Smt Anandiben Patel. While we have not heard from either the Dean or Anandiben’s office, someone has definitely asked questions regarding the case. The doctors of Taktshihji Bhavshihji Hospital apparently started investigating who was passing information to outsiders (us). Dr Gosavi called the President of the local NGO inquiring about the author and mentioned they were being harassed.
It has been 49 days since the bite occurred on 24th May 2015. Mohit lies lifeless in the hospital bed of Taktshihji Bhavshihji Hospital, being fed through tubes. He cries incoherently and continuously. His parents tend to him day and night. Mohit’s father, Rajender Yadav has no income at the moment as there is no paid leave facility in his factory. His other two children live in the corridors of the hospital as there is no one to take care of them at home. All are hoping for a miracle. Their meagre saving is fast depleting. There is little hope for the child to bounce back to normal health once again.
Snakebite Healing and Education Society is of the opinion that this is a complex case and best dealt with by consulting snake bite expert doctors and pediatric neuro-surgeons to deliberate on an aggressive treatment to stunt the damage done to the brain.While brain cells once dead cannot be regenerated, it is every Indian citizen’s right to be provided with the best of efforts to reverse a serious health condition. Time was of essence here! It was unethical on the part of the ground doctors to reject help by not talking with subject matter specialists.
Written by Priyanka Kadam
Founder – She-India.org
Bachuben Shamjibhai Nadasiya was a 65 year old widow who lived with her 4 sons in Bhagamda Village, DhandhukaTaluka, Ahmedabad District, Gujarat. The family lived in a mud house with a thatched roof made of bamboo. The courtyard outside the house was fenced with thorny bushes to deter animals from entering the house. Bachuben’s four sons are all farmers.
The sacks full of produce from their farm were stored inside the house, in the attic and in the corners of each room to ensure they were not rain soaked or plundered. Rodents, however, were a part of their household.
Bite incident: On 20th June 2015, Bachuben was cleaning wheat grains to be crushed in the flour mill. After finishing the chore she began to sweep the floor, where the grains had spilled over, with her bare hands. A few grains were strewn in between the sacks. When she put her right hand into the hollow between two sacks to collect the spilled grains, a cobra, that had probably entered the house after a rat, bit her on the third finger.
In the past there were many instances when snakes had entered the Nadasiya household. The family would capture and release the snakes in the fields nearby. Being followers of Vasuki, the snake god, they would never kill snakes.
Bachuben was taken to the Vasuki temple’s priest. She walked all the way to the temple which was about 500 meters away. The priest chanted mantras and put a white cloth, knotted from both ends around her neck and asked her to go home. He told her that she was cured. Bachuben walked back home. Her family members waited for the next 40 minutes and when she didn’t show signs of trauma that accompanies an envenomation from a venomous snakebite they took her back to the Vasuki temple to pay obeisance to the snake god.
Bachuben was brought back home and within a few minutes, she started showing signs of snakebite related stress. She vomited a few times and started feeling breathless. Seeing the turn of events, the family members and neighbours decided to take her to the hospital in Bhalgamda which was 3 kms away from their village. When they were on the way Bachuben’s brother called and asked about her condition. When he was told that her condition was worsening, he convinced everyone to come to Akru (his village). He told them that the faith healer of Akru was very gifted and that Bachuben would be cured in no time. The group turned and headed for Akru village which was 5 kms away. The faith healer of Akru made slight cuts near the bite area and sucked the blood from the incisions.
When the treatment provided by both the faith healers did not bring any relief and Bachuben’s condition started deteriorating, the family realized that they must rush her to the hospital in Dhandhuka which was 25 kms away from Akru. While on the way, they called the hospital and were informed that the hospital did not have a ventilator. A ventilator is a vital equipment to treat serious neurotoxic snakebite cases as the patient slips into a coma if not treated immediately. The hospital staff advised Bachuben’s family members to take her to Paliyad which was 50 kms away from Dhandhuka in Botad taluka. By the time they reached Paliyad, Bachuben was struggling to breathe. She passed away approximately 5.5 hours after she was bitten by the spectacled cobra.
The family was distraught and brought her body back to the village. Two days after Bachuben’s death, the author spoke to Bachuben’s second son, Manjibhai, who took a vow that they would never again rely on faith healers. Sadly. a realization which came too late to save the life of their mother.
Written by Priyanka Kadam
Snakebite Healing and Education Society has agreed with the family to do a Snakebite first aid awareness program in the village to ensure every villager knows what to do in a snakebite situation.
This story was reported by Vijay Rathod, a school teacher in Shree Dholi-Bhal Primary School, Limbdi. Gujarat.
Victim’s Background: Jayanth Krishnappa is a 14 year old boy studying in the 9th grade. He lives with his parents and elder sister in Malur, in the Kolar district of Karnataka. His father works in a factory and his sister studies in junior college. His mother is a home maker.
Bite incident: Jayanth ‘s favourite game is cricket. He and his friends play the game in a sports field close to his house. On 14th June 2015, around noon, just like any other day, Jayanth along with his friends was playing cricket. His friend hit the ball hard and Jayanth went to retrieve the ball that had got lodged in the bushes. A Russell’s viper that was foraging in the bush got disturbed and bit Jayanth’s right foot just above the toes. It was 12.30pm.
Jayanth quickly rushed home and informed his parents about the bite. The local area started to swell in a few minutes and Jayanth started experiencing intense pain. Krishnappa rushed his son to Manipal Hospital in Bengaluru. They reached the hospital 3 hours after the bite incident. A total of 12 vials of ASV were administered to Jayanth. He stayed at the Manipal Hospital for 5 days. The cost of treatment there was Rupees One lakh ten thousand (Rs 1,10,000).
Krishnappa has now shifted his son to the Srinavasa Hospital in Hoskote. Jayanth is receiving treatment from Dr Nagraj, a snakebite expert. Since this is a hemotoxic bite the necrosis is spreading to other parts of Jayanth’s foot. It will be a while before the wound heals.
Written by Priyanka Kadam.
Photo credits: Dr Nagraj, Srinivasa Hospital, Hoskote.
Victim’s background: Parmar Natubhai Hamirbhai was a 56 yr old construction labourer from Khadol village in the Dhandhuka taluka, Dist Ahmedabad, Gujarat. Apart from his day job as a construction worker, he was also a snake rescuer and villagers from in and around Khadol used to knock at his door to rescue snakes from their houses and farm. Natubhai had been rescuing snakes for the last three decades and was previously bitten by snakes. Natubhai is survived by Madhuben, his wife and three children, Chandrika, Hira and Upendra.
Bite incident: On Thursday, 18th June 2015 a villager came calling Natubhai to help remove a Cobra from his courtyard. The villager had tried his best to move the snake away from his house. However the snake was trapped and being cornered took refuge in a hole.
It was around 10.30pm. Natubhai had consumed liquor that evening and was sleeping. His wife tried to dissuade the villager but the loud conversation woke him up and he proceeded along with the villager to remove the snake from his house..
When the duo reached the house, the Cobra had come out of the hole a little bit. Natubhai caught the snake by pinning its head. He held the snakes head at an angle for the snake to be able to twist its head and bite his palm. Natubhai shrug off the snake and the reptile quickly slithered back into the hole where it was hiding earlier.
When the snake didn’t come out of the hole for a while, Natubhai put his hand in the hole and pulled out the snake. The agitated snake bit Natubhai once again on his hand. Natubhai captured the snake in a plastic jar to be released near by. He then made slight incisions near the bite area and sucked out the blood . Natubhai believed that venom could be extracted from the body in this way.
Natubhai released the snake in the fields a little away from the village. He didn’t confide about the bite incident to his family. He came back around 11.30pm, eat his dinner and while he was preparing to go to sleep, he started vomiting. When his family got to know about the cobra bite incident, they quickly called 108 helpline for an ambulance to take Natubhai to the nearest Govt hospital. The vehicle arrived in 30mins. The paramedics tried to revive him. However Natubhai expired a little after 12am (2..5 hours after the bite had occurred).
This story was reported by Vijay Rathod, a school teacher in Shree Dholi-Bhal Primary School, Limbdi. Gujarat.
Written by Priyanka Kadam.
Note from the author: Snakebite Healing and Education Society is documenting stories of rescuers who turned victims. Most rescuers in India have little knowledge of how to administer first aid in a snakebite situation. This story is one amongst the many we will be documenting to create awareness amongst the rescuer community. Every month rescuers die across India as they have not learnt to manage the risk associated with handling venomous snakes.
Sukhmoti Maran Patel is 38 years old. She is a resident of Lakshmipur village, Pithora tehsil of Mahasamund district, Chhatisgarh. She is married and is the mother of four children. Her husband, Pautram, works as a farm labourer and vegetable vendor. They have a cow and sell milk on the side. Pautram does odd jobs to supplement his earnings.
The family lives in a three room cemented house with a thatched roof. They have a pucca cow shed. Their house has electric supply but the cooking is done on firewood which Pautram collects by making two or three visits to the forest per month.
BITE INCIDENT: Sukhmoti was bitten on the third finger of her right hand on Nov 11, 2013 at twelve noon. The snake was hiding in a bamboo used to support the extended roof. She had gone to hang a bag on a peg nailed to the bamboo when she was bitten. She did not see the snake. But later events, including envenomation of the victim and capture of the snake, proved that it was a spectacled cobra (Naja naja). Pautram had gone to sell vegetables and was not expected back soon. Sukhmoti’s children sent a message to Pautram through a neighbour who also sold vegetables in the same market. The neighbour forgot to convey this very important message to Pautram. He finally remembered after 2 hours. On hearing that his wife had been bitten by a snake Pautram hurried home and reached around 4 p.m. During this time Sukhmoti had drunk copious amounts of water. She was finally taken to the hospital – the Anjali Health Centre in Lahrod, Pithora.
After reaching the hospital Pautram rang his neighbour and requested him to catch the snake and to bring it to the hospital. The neighbour, who was a devotee of Lord Shiva, agreed to catch the snake only if he was given an assurance that it would not be harmed. On getting the assurance he captured the snake from inside the bamboo and tied it to a stick. It was then taken in a procession to the hospital with hundreds of people following.
Sukhmoti was brought to the hospital 5 hours after she was bitten. Her vision had started blurring and she could not recognize anyone. Her tongue was paralyzed and she could hardly breathe. She was administered 6 vials of ASV along with supporting drugs and medicines. She was kept in the hospital under observation for seven days. After she was discharged she visited the hospital regularly for the next three months for treatment of the necrosis which developed in the bite affected area.
Once Sukhmoti ceased to be in a critical condition, the snake was released in a dry river bed. The story could have ended tragically for the bite victim or for the snake but this is a rare case where both survived.
Written by Dev Kumar Vasudevan (as narrated by Priyanka Kadam)
Binod Yadav is a 15 year old boy, studying in 8th standard in a Hindi medium school, Prathmikshala, in his village Chindauli , P.S. Patewa, Chhattisgarh. His father is a farm laborer, and his mother does odd jobs (maid and farm laborer). Binod has a younger brother. They live in a two roomed cemented house with electric supply. Their food is cooked on firewood. His father, Baisakhu Yadav, around 31 years old, collects wood 2-3 times a month from the nearby forest area. Baisakhu Yadav works for a rich farmer. He has a Rashtriya Swasthya Bima Yojna (RSBY)card, a scheme for families below the poverty line. As per this health policy, a family can use the RSBY card to avail of health related treatments upto Rs.30,000 per annum. Each family owning a smartcard has to pay a premium of Rs.30 per annum to avail this facility.
Under this scheme a family can use a maximum of Rs.10, 500 to spend on treatment in case of a snake bite. Being illiterate, Baisakhu panicked at the thought of the extensive paper work that would need to be done to avail this facility. Moreover it was paddy sowing time and his boss offered to give him a loan instead.
BITE INCIDENT (23rd June 2014) : Binod was lying on a patch of grass in a farm and watching a video on his mobile. When he moved his hand, a snake resting in the grass bit him on the third finger of his left hand. As soon as Binod was bitten, he ran home and immediately tied a tourniquet around his wrist. Binod was not able to identify the snake and hence one was not sure if it was a venomous snake bite. He was brought to Anjali Health Center in Lahrod, Pithora for treatment, which was 20 kms away from his house. By the time he arrived at the hospital, he was showing signs of envenomation. He stayed in the hospital for three days. The author met Binod after one week of the bite incident when he came to Anjali Health Center for dressing of the local area.
MEDICAL HISTORY: Three vials of anti-venom, pain killer, anti-allergy, and antibiotics were administered to Binod. He was having regular food, and passing normal urine. Necrosis developed in the bite area four days after the bite. He had intense pain for six days, and is now losing sensation on the tip of his bitten finger. He feels pain in the bitten area only if the finger is pressed with a pair of tweezers. Slight cramp like sensations are also felt in the affected finger.
Written by Priyanka Kadam
Joydev Mondal, resident of Basanti, Canning Sub Division,South 24 Parganas district of West Bengal was a snake rescuer representing the Juktibadi Sanaskritik Sanstha (JSS), Canning. He died of snake bite on 18 April 2014 at the Gosaba Village Health Centre. He was thirty-five years old, married with two children – a son and a daughter. The younger child was barely two years old when he died.
Joydev was a popular figure locally. He had worked with the JSS for twelve years and had saved the life of many a snake bite victim by taking them to hospitals and not letting them go to local faith healers. This includes an incident when he had taken two children who were snake bite victims to a hospital, something which had endeared him to the entire community.
On 17th April 2014, a day before his death, Joydev had rescued 2 Juvenile Spectacled Cobras (Naja naja). On the fateful day, he was bitten while showing the snake to a forest official. He had caught one of the juvenile snakes by the tail and being small in size it turned back and bit him. Inspite of being an expert Joydev had committed a fatal error – he had forgotten that a juvenile snake being small in size can easily reach near its tail area. Initially Joydev ignored the bite as it was a slight scratch. On the advice of a few well-wishers, he proceeded to the Gosaba Health centre which was on the other side of the river. Precious time had elapsed as he had to wait for the local ferry etc. On arrival, Joydev was administered 20 vials of ASV. A supporting drug, Neostigmine which is supposed to be supplied by the government to every govt hospital and costs somewhere around 10 to 14 rupees was out of stock.
Members of JSS collected Neostigamine from Canning hospital and hurried to Gosaba. But before they could cross the river to Gosaba, news came in of Joydev’s death. As per newspaper report, Dr Samar Roy from Canning hospital and Dr Dayal Bandhu Majumdar both snakebite expert doctors in West Bengal claim that if Neostigmine had reached on time Joydev’s life could have been saved as it would have helped reverse the neurotoxic symptoms (nerve paralysis) due to the Cobra bite.
Point to be noted here is that a Govt. Hospital located at may be the most snakebite prone area of West Bengal did not have the essential drug. The doctors on the ground did not check on this essential life saving drug inventory. According to Dr Majumdar the total cost of vials of ASV used in this case was Rs 8,000 (Rs Eight Thousand) but the Neostigmine injection costed a mere Rs 14 (Rs Fourteen). To add to this, the health care personnel were not able to intubate Joydev and he finally died due to airway obstruction with mucus secreted from the respiratory tract. If Joydev was resuscitated with an ambu bag or life support system at that point, he would have had a better chance of survival.
At the end of it all we have the sad case of a young man dying in the prime of his life due to an act of carelessness on his part and highest level of inefficiency of the government rural health centres who do not take the treatment of snake bite with the seriousness that is needed. An ambu bag which is an affordable equipment and can be manually operated or a portable life support system could have helped save Joydev’s life.
His wife must wonder every day whether it was that difficult to save her husband. Joydev’s children lost their father as toddlers. A whole family’s life changed forever due to this unfortunate incident.
Written by Dev Kumar Vasudevan & Priyanka Kadam with inputs from Dr Dayal Bandhu Majumdar, Dr Samar Roy and Prabhudan Haldar (A retired school teacher from Basanti, WB).
Koushik Barui is a 25 year old resident of Gairkata (district Jalpaiguri, West Bengal). He is a student of MA Part 2. His father has a cloth shop and his mother is a home maker. He has 2 sisters , both are married. Koushik is a member of an NGO named Gairkata Aranyak, . He has been a snake rescuer since the last 4 years and was bitten earlier by a rat snake.
Bite Incident: On 13th Sept 2012, Koushik got a call at around 6pm in the evening from a shop keeper informing him that there was a large snake on the road outside their shop. On arriving at the spot he saw that the snake had crossed the road and was in a dry nullah. Koushik wanted to leave it alone but the shop keeper insisted that they bag and relocate the snake. By this time some others had arrived with sticks to kill the reptile and Koushik decided to bag it. It was getting dark. There was a slight injury near the tail of the snake. No sooner had he caught the snake’s tail and lifted its body with the tong , the snake lunged backwards and bit his left hand. Koushik bagged the snake thinking it was a non-venomous rat snake. It was 6.30pm.
When he arrived at the Forest Department (FD) office with the snake, the members of Gairkata Aranyak identified the snake as Common Krait. It was a healthy, massive sized snake. As it was injured it was kept for treatment by the local vets.
The local tea garden hospital provided 10 vials of anti-venom that was stocked with them. Koushik was rushed to Birpara hospital about 12 kms from Gairkata where the 10 vials of anti-venom were administered. He was then shifted to the better equipped Jalpaiguri District hospital, 62 kms from Birpara. Koushik began to vomit on the way and had problems with his vision. His throat felt extremely dry and breathing was getting laboured with each passing minute.
There was no ICU bed available at the Jalpaiguri district hospital and the doctors managed to secure a bed in Marina Nursing Home – a private hospital which was close by. Koushik was finally admitted in Marina Nursing home at 8.45pm, 2.15 hours after the bite incident. Later that evening Koushik slipped into a coma and his condition remained unchanged for the next 3 days.
In the meantime the members of Gairkata Aranyak had a shocking revelation. The rescued snake was a Wall’s Krait. Until then, no one was aware that the region had Wall’s Krait distribution.
Koushik was administered a total of 33 vials of anti-venom and after a slow recovery, he was shifted to the general ward and stayed at the hospital for one week. He was under the treatment of Dr Kumar Atanu and the cost of treatment was borne by Gairkata Aranyak (NGO). A total of Rs 80,000 was spent on his treatment.
Meanwhile the snake’s injury was treated by local vets and it was released near a tea garden on the outskirts of Gairkata after it had recovered fully.
After being discharged from hospital, Koushik was still weak and didn’t regain his sense of taste for the next 2 months. His left hand felt numb accompanied by pain near the ring finger (the area where he was bitten). It is almost 3 years since the bite incident and he still experiences pain in his left hand at least once a week. On regular intervals tiny boils erupt between the middle finger and the ring finger with oozing fluid accompanied by itching. A skin ointment has been prescribed by the doctor to keep the skin condition under control.
This incident could have been avoided if care was taken to ID the snake before rescuing it. Koushik admits it was his own folly that put his life in grave danger. He is now more cautious while on rescue calls. The area around Jalpaiguri has a healthy sighting of Wall’s Krait. Koushik has rescued 8 Wall’s Krait last year (2014) along with other venomous & non-venomous snakes.
Written by Priyanka Kadam (as narrated by the victim).
Victim’s background: Dharmendra Trivedi lives in Gandhinagar, Gujarat. He has worked as a translator in the Gujarat Vidhan Sabha since 1991 and served the then CM Narendra Modi between 2009-2014. He is now a part of the team of the present CM Anandiben Patel. He is married to Shilpa Trivedi and they have a 12 year old daughter, Hirva.
Bite Incident: It was the 8th of July 2008. I was in a bit of a hurry to reach my office when I received a rescue call from an IAS Officer in my city, Gandhinagar-Gujarat. Along with a fellow rescuer I reached the site and saw a big cobra trapped under a huge square cement block. At that time I was not aware that the cobra had been injured by the IAS officer’s family members. Nobody cared to intimate me. I lifted the block from the cobra’s body and it tried to slither behind a potted plant. As I tried to hold its tail it struck the back of my right hand with lightning speed. The snake struck so swiftly that even I wasn’t able to see it biting me. I just felt a slight prick.
After safely depositing the snake in a steel box, I rushed to the Civil Hospital. Immediately after the bite, I experienced severe burning sensation on the bitten area and the swelling started within 15 minutes of hospitalization. Amazingly, I was composed and my blood pressure was normal. There were no other symptoms of envenomation and I reached the Government Civil Hospital within ten minutes of the bite incident. Two vials of anti-venom were administered immediately on my arrival. The affected hand developed heavy swelling on the second day which decreased after the 4th day. Finally I was relieved from the hospital on the fifth day. Totally five vials of anti-venom were used for my treatment.
While I survived the bite, on the first day of treatment an intern rubbed the bite area due to her curiosity to see how a snake bite looks. This caused severe necrosis in the local area. I underwent surgery after 15 days to remove dead tissues. In the coming months I had to undergo skin grafting of the affected area. The tendon of my middle finger still feels sensitive to touch.
I’m sharing my story because my personal opinion is that doctors need to be trained to handle such emergencies. The reality is that in most cases doctors all over India are referring to manuals that are archaic and published decades ago. While science has progressed from that era, our medical journals and manuals have not been updated. A venomous snake bite is a life threatening situation which can be treated successfully if the victim is lucky enough to get to a doctor with the right experience and knowledge. Why should such matters be left to chance? Why can we not have trained doctors to ensure that no snakebite victim dies or suffers due to a medical goof-up?
Written by Dharmendra Trivedi.
Name: Sunil Vijay Sahasrabudhe; Age: 43yrs
Victim’s background: Sunil V Sahasrabudhe is married and has an 8 year old daughter. He runs a small printing business.
Bite Incident : This is the story of a snakebite incident that happened right in the hustle and bustle of a busy city. On 30th Oct 2013, Sunil was returning from Badlapur on his scooter. The roads were dug up for widening purposes and as he approached Newale Village (between Dombivli & Ambarnath MIDC), he realized there was a serpentine traffic. The only difference was that no one was honking. It was around 7pm and getting dark. He got off his scooter and went on foot to investigate the reason for the traffic jam. Right in the middle of the road was a grey morphed Spectacled Cobra hooded and hissing at the milling crowd.
Sunil is an animal lover and wanted to ensure the snake is safely moved to the side of the road. He started plodding the snake to the other side of the road. The snake panicked and started slithering towards the now slowly moving traffic on the other side of the road. Sunil again tried to move it away from harms way and the snake by now slithered under his scooter. In a few minutes, the snake was on top of the scooter. Sunil managed a head catch of the hooded snake and carried it close to a bush to release it.
In his inexperience of handling snakes, he didn’t realize how he was risking his life by slowly loosening his grip during the release. The snake barely nipped at the index finger of his left hand. When he realized he was bitten, he released the snake in the bushes and immediately asked an onlooker, Chandrakant to help him get to a nearby Public Health Center (PHC).
It took them 20 mins to reach the PHC. Anti-venom was not available at the center. They administered a tetanus injection and Sunil was on the road again, headed to Thakur Memorial Hospital in Dombivli as advised by his family doctor, Dr Amit Kulkarni. Though this was a private hospital, they had a ready stock of anti-venom. Ironically instead of immobilizing the patient, Sunil had to climb stairs to get to the casualty ward on the first florr. where he was ultimately attended to.
By this time he was showing signs of envenomation with rapid swelling of the local bite area. Sunil’s vision was deteriorating and he was fast slipping into an unconscious state. Sunil was immediately admitted in the hospital’s Intensive Care Unit and was on the ventilator for the next 24 hours. He was later shifted to the general ward and discharged after 5 days of care under Dr Verma. A total of 14 vials were administered to treat Sunil. The cost of treatment was close to Rs 90K.
This incident though stressful for the entire family has not left Sunil paranoid about snakes. He admits it was his own wrong doing that landed him in trouble. Since the bite, there have been 3 incidents when snakes have entered his house in Dombivli. He chooses to leave the snake alone and slither away on its own. His daughter is being raised to love animals including reptiles but also be respectful and keep a safe distance from wild animals.
Written by Priyanka Kadam.
Name : Aakash Laxman Dhangad; Age: 9 yrs
Father: Laxman Dhangad; Mother: Manisha; 2nd brother Roshan (7yrs); Youngest brother Amit (5yrs).
Address: Patoni Pada, Yeor Village, Dist & Taaluka: Thane
Date of bite : 21st April 2014.
Incident : Aakash is a 9 yr old boy studying in 4th Standard in a village school in Patoni Pada in the Yeor Village, Thane. His father Laxman Dhangad is a construction labourer and mother is a maid. He has two younger brothers. On 21st April 2014, Aakash along with his friends was playing in an open patch near his house. It was around noon time. The kids saw a Russell’s viper chasing a rodent. Aakash went a little too close and got bitten by the Russell’s right below the knee of his right leg. The snake later disappeared under some construction pipes.
Aakash ran up to his aunt who was babysitting the young boys. Aakash was taken to the civil hospital in Thane. He reached the hospital almost 1 hour after the bite incident. By then he was displaying severe signs of envenomation. His bite wound was continuously bleeding with progressive swelling. He developed Ptosis (involuntary drooping of eyelids) and had trouble breathing. Aakash was put on life support and administered Anti-venom. Aakash remained in the Civil Hospital for 5 days and later shifted to Sion hospital. His leg developed severe necrosis and hence he was forced to remain in the hospital for the next 2.5 months. He was later discharged and was home bound most of the next few months. Aakash’s parents spent close to Rs 80K to save his life. The growing cost of treatment made Aakash’s parents try out herbal remedies suggested by a local healer. His wound had festered and needed immediate medical attention. A local NGO by the name Nisarga Vidnyan Sanstha reported this incident to SHE and sought help for the victim. This was 10 months after the near fatal bite that Aakash had sustained.
Snakebite Healing and Education Society (SHE) helped with the treatment and Aakash underwent skin grafting surgery in March 2015. Since his wound was old and a few areas had negligible blood circulation, the healing process took another 2 months to heal.
Written by Priyanka Kadam
Kirti Sahu is a 23 year old widow from Digepur Village in the Pithora District of Chhattisgarh. She has two very young children and lives with her in-laws in a mud house with nine other people in the family. It was Sept 2012 and the rains had just set in. Kirti was in her first trimester of pregnancy and had gone to answer nature’s call in the fields. She accidentally stepped on a Russell’s viper that bit her just above the toes. She was taken to the Government hospital where anti-venom was administered and the doctors advised aborting the baby as there was a possibility of an adverse effect of the venom and anti-venom on the unborn foetus. But the couple decided to keep the baby. Kirti was later shifted to Basna to a local healer. She was brought to the Anjali Health Centre in Lahrod after about three days of the bite incident.
After spending four days at the Anjali Health Centre, Kirti was shifted to the Raipur Government Hospital and then to Baruda, near Raipur,to live with her mother for further treatment of the necrosis. The high medical expenses and a pregnant wife suffering with severe necrosis was taking a toll on Kirti’s husband, Paras Nath Sahu. In the coming months he was debt riddled and under severe financial crisis. Paras Nath committed suicide on 13th Dec 2012 by consuming insecticide. He was found unconscious in the fields by his family. He was admitted to the hospital and died the same day.
Kirti’s son Tikeshwar was born on 22nd April 2013. Tikeshwar is an active and happy child but blind in one eye. Kirti has no source of income. She receives a monthly pension of Rs200 under the widow’s pension scheme for BPL (Below Poverty Line) card holders in Chhattisgarh. This money is credited into a bank account which is 5kms away from her village.
The purpose of sharing this story is to demonstrate the socio economic scenario in rural India and at what level a venomous snakebite can affect a victim’s life. Snake bite is a curable condition and should be included in all state level health policies with a focus on free treatment to all victims that report to a government hospital. The scarcity of ASV (Anti Snake Venom) has raised the price of a single vial in the retail market to almost Rs950 – Rs1,050 in many places in India. The government should make available ASVs at every single health care unit in rural India. No Indian should die of snakebite in an otherwise progressive country.
Written by Priyanka Kadam
This is the story of Khumesh Thakkur, a 9 year old boy belonging to the Gond community from Lakhagadh village in the Pithora District.Khumesh has a cute smiling face and was happy to skip school to meet us. Khumesh lives in a household consisting of 18 people. His father Punna Ram is a mason who earns approximately Rs 200 per day. On an average, Punna Ram is able to find work for approximately 10 days in a month. Khumesh’s mother is a housewife who does odd jobs to make ends meet.
Khumesh was bitten on 8th July 2013. On the fateful day he had gone to school. It was close to noon time. All the children were playing in the open area in front of the school. A neem tree stood tall in the middle of the open space. Khumesh was resting against the trunk when a snake came out of the little crevice at the root of the neem tree. It all happened in a split of a second. The snake bit Khumesh in between his toes and disappeared into the slit of the root. As Khumesh sat crying a few children ran to inform the only male teacher of the school, Lekhram Dewangan and Santosh Kaur Hora, Khumesh’s class teacher.
Lekhram tied a tourniquet close to Khumesh’s knee and immediately took him to Anjali Health Care center on his motorbike. Since no one had seen what had bitten Khumesh they were not able to explain the cause of the severe pain. The resident doctor Sr Sijji was doubtful it was a scorpion sting. The local bite area had an on setting oedema (swelling with fluid accumulation) and the child was in severe pain. The symptomatic condition was diagnosed as a venomous snake bite and AVS (Anti Venom Serum) was administered.
After 12 vials of AVS within a span of 3 days, Khumesh was referred to a District level hospital to treat the severe necrosis (local area tissue damage) spreading on his right leg. None of the doctors wanted to take up the case and kept referring the patient to other doctors in the same hospital. An overwhelmed Punna Ram brought his son back home and opted to visit Anjali Health Center for regular dressing of Khumesh’s wound.
After 15 days of treatment, Punna Ram stopped coming to the health center with his son. The doctors lost track of the case and in July of 2014 when we were visiting the region collecting data on snakebites, the missionary nuns tracked down Khumesh’s case.
After one year of the snake bite incident, Khumesh’s wound has still not healed. High cost of treatment has made it impossible for Punna Ram to pursue the treatment. He was given Rs 500 cheque by the state government as compensation for the treatment which he refused to accept. Meanwhile morbidity has set in and the child’s leg has become deformed. Khumesh now walks with a sever limp.
Written by Priyanka Kadam.
The two nuns from the missionary hospital and myself had travelled the whole day visiting villages meeting snake bite victims. At the end of the day we reached the periphery of Pithora District that was hemmed from three sides by mixed deciduous variety of trees. The sun was quickly disappearing behind tall trees as we reached Samaroh Bariha’s village. Samaroh was not home and the fast receding rays made us jittery as the area was naxal riddled and cut off from the main road.
Samaroh Bariha lives in a beautiful village called Jambhar, in the Pithora district. He is a local healer for regular ailments. He is 55years old and a daily wage laborer. He earns a daily wage of Rs 100. However he is able to find work far apart. He lives with thirteen others in a house constructed of bricks and mud surrounded by animal pens housing cows, goats, parakeets and dogs. The village is nestled in the Janhar forest.
It was a Sunday and Samaroh was working in the brick kiln. While moving bricks, a Spectacled Cobra which was hiding in between the bricks latched on hard to the index finger of his left hand. Samaroh yanked the snake free with his right hand. He had severe local area envenomation with neurotoxic signs from an elapid snake bite. The bite incident occurred at 11am and he reached Anjali Health Centre by 12.30pm. He was in the hospital for eight days.
We met Samaroh after one month of the bite. His finger had developed severe necrosis. Samaroh applies honey on the affected area. We tried persuading him to visit Anjali Health Centre to dress the wound and then approach a Government hospital to amputate the finger. While he nodded, I was sure he would not come for treatment.
Samaroh was given 10 vials of Anti-venom (ASV) along with other supporting drugs. Once he was relieved from the hospital, he did not return to dress the wound. This has led to severe gangrene on his finger.
Written by Priyanka Kadam